Healthcare and home care services are undergoing major changes in their operating environment in many countries, such as an increasing number of clients, changing organisational and service structures, challenges in finding enough staff, as well as financial challenges. Digitalisation is expected to play a key role in these services, but the field is also very complex and digitalising it in a meaningful, ethical and effective way will be a challenging task.
The Covid-19 pandemic accelerated the introduction and use of various types of distance spanning solutions in healthcare and home care services, but climate impacts have not been the key driver of the digitalisation of these services. The wider adoption of emerging technologies such as robotics and artificial intelligence will likely increase the challenges of climate impact assessments. Such developments highlight the need for increasingly active assessment activities in the future.
This part introduced a novel methodology to assess environmental, especially climate impacts, and the related social impacts of digital healthcare and care services. We also presented the results of our combined quantitative and qualitative assessments concerning the impacts of distance spanning home care services in Finland, focusing on medicine robot services for older people. The study showed how such distance spanning solutions in health care and care can contribute to the green transition. We also gave practical guidance for future impact assessments.
Digitalisation is generally considered a positive measure for the environment. However, at least some negative climate impacts result from every digitalisation action due to the equipment and energy that are needed. Concrete practical tools are required in order to assess the impacts of digitalisation in the field of health care and care. The key results of the case study on medicine robot services offered a multidimensional picture of the impacts of distance spanning solutions, both climate impacts and the intertwined social impacts on clients/patients, care professionals, service organisations and society.
An important lesson for the field of healthcare and care services is that a well-planned and well-implemented digital service is likely to be a climate-friendly option, but the design, architecture and practical implementation of digital services greatly affect their climate and social impacts.
Based on the results, multi-perspective and multi-method impact assessments should be advocated to advance the green transition. In addition to quantitative assessment - and to help interpret its results - a qualitative understanding of digitalisation and its impacts is needed, especially when access to numerical data is limited. A systemic understanding of a service context in which everything affects everything is essential to properly comprehend and advance the entire sustainability mindset in healthcare and care services.
The differences between services and service contexts can be significant. Appropriate policy measures could speed up the proliferation of impact assessments. Conducting climate and social impact assessments in a holistic way will contribute to reaching a more meaningful, optimised balance of the impacts of distance spanning solutions in the future, thereby achieving the strategic priorities of a green, socially sustainable and competitive Nordic region.
Endnotes
The definition (scope) of health care can vary across countries and their different service systems. In most instances, health care and care are used side-by-side in this part to also cover elderly care, such as home care.
The savings ranged from 0.70 to 372 kg CO2e per consultation but were noted to be highly context-specific. The mode of transport was usually assumed to be a car, but even air travel scenarios were considered. The most comprehensive LCA was found to be the study by Holmner et al. (2014), where it was estimated that the studied telerehabilitation service became carbon cost-effective if the patient travel distance was over 7.2 km.
We also studied video call services for older people as well as remote healthcare appointments in dental care, nutritional care and mental health and substance abuse services for children and youth; see Melkas et al. (forthcoming) and Tuominen-Thuesen et al. (2022) for further information. Subsequent sections of this part are partly based on and adapted from the above-mentioned publications.
Funding
The work on this part 1 of the report was supported by the Finnish Prime Minister’s Office (“Sustainable digitalisation of public services: climate and environmental impacts”, 2021–2022) and the Nordic Welfare Centre.