How green is greenCDA?

The answer is, “potentially, pretty darn green.” I was invited to speak at the 2nd Annual Global Healthcare Conference where the topic is the greening of healthcare – reducing the environmental impact of care delivery in the US and around the world (it is held in conjunction with a meeting on medical tourism. That’s another topic.) It seemed like a good opportunity to exploit the name and bring the message of radical simplification to a new audience. (Those new to greenCDA, see here.)

Researching The Green Revolution in Health Information Technology, to my surprise and pleasure, I found extensive research done by Kaiser Permanente on the environmental impact of electronic health records. The title of the article by Marianne Turley, Catherine Porter, in Health Affairs gives away the punch line: “Use of Electronic Health Records can Improve the Industry’s Environmental Footprint”. Bottom line, they found that the environmental impact of Kaiser’s HealthConnect was positive. The major impact was on greenhouse gases which gained the equivalent in acres of carbon sequestration:

  • 4,200 from decreased use of paper records
  • 257 from decreased use of x-ray covers and forms
  • 6,400-9,200 from fewer trips (less gasoline)

At the same time, there were negatives (again, in equivalent acres of carbon sequestration):

  • 810 from print out of summaries
  • 283 from PC packaging
  • 13,300 from PC and data center power usage

Poking through the data we see that without the reduction in emissions from fewer trips – 16-25% — the net impact would have come out on the negative side. This is key as we look at how reproducible the results from Kaiser are likely to be as more EMRs are introduced and to the tie-in to the HL7 greenCDA.

HealthConnect is a single entity spanning the full spectrum of care with information flowing from clinic to hospital to consultant to lab to patient to pharmacy to geriatrician. It is estimated that in the care of a patient, 80% of the information needed will, at some point, need to cross an organizational boundary. So, a potentially testable hypothesis is that to reproduce the positive impact found from HealthConnect, information needs to be fluid. Standards make that possible and greenCDA, therefore, by making it easy, makes it more probable that benefits will be realized.

And there is a second, strong tie to standards in the incentive to reduce visits. The shift from payment for quantity to payment for quality is only possible through information-based measurement. Here, too, a specification that is sufficiently general to encompass all types of reporting and exchange and yet simple enough that any XML developer can work with it – that has a true claim to greenness.

It turns out, as well, that there are other things we can do while implementing our IT systems. Making smart choices for centralized infrastructure will minimize power requirements and using our purchasing power to promote non-toxic and recyclable components can help as well.

I found two major guides to green building for healthcare: LEED for Healthcare and the Green Guide for Healthcare. While both have some criteria related to HIT, it is possible to become certified in both without any effort to leverage it.

Here is the full set of slides I presented.  I’d love to know what you think of the concept.