The federal government has mandated that the healthcare industry digitally document every patient by 2014. But will making this transition to electronic medical records have a positive environmental impact? It's possible, say two technology experts, but not without careful considerations.

They save trees
Conservation is not the main reason why most healthcare facilities take their charts electronic. "All business decisions have primary, secondary, even tertiary focuses," says Nancy L. Richards, CDIA, CRM, CSM, a senior principal at the Seattle, Wash., consulting firm Business Arts Management. The key drivers behind the adoption of EMRs are the anticipation of a legislative requirement to do so, the ability to better manage billing to third-party payors and the efficiency improvements they bring to a clinical staff's workflow, says Ms. Richards.

But there are environmental benefits: EMRs do use less paper. Ideally, they'll be able to assist healthcare facilities in consuming fewer resources (the paper itself; the trees, water and energy required for its production) and reducing their impact (the pollution and potential climate change engendered by paper manufacturing, the landfill space or incineration if discarded paper isn't recycled).

That can add up to a significant impact across the industry, says Ms. Richards. Consider a simple action from the reception desk. "You take a patient's insurance card, photocopy the front side, flip it around and photocopy the back side, quite possibly on two sheets of paper," she says.

Then there's the chart. Intake forms, history and physical forms, operative notes, lab reports, faxes: not just yours, but all the copies you've sent to and received from the patient's other providers. In the aggregate, that's a lot of paper, she says, citing an Association for Information and Image Management statistic that an average document is duplicated 9 to 11 times during its lifespan.

Less paper isn't the only environmental benefit. There's also the energy and toner cartridges used by office printers, copiers and fax machines to produce, reproduce and transmit that paper. "If we move beyond just paper, there's a lot of things in hard copy records," says Ms. Richards. The process of producing and discarding photos, X-ray film and other non-digital images exacts a potent toll, as do the vehicles that might be required to transfer boxed-up records to and from off-site, climate-controlled storage spaces.

Compare these factors, she says, to a single source of accessible information, inputted once and integrated with other systems to receive faxes, invoices, imaging and lab reports electronically, resulting in a significant reduction of the amount of paper that needs to be managed in your facility. Ms. Richards describes the advantages as "G-squared": "We save green environmentally through a reduced carbon footprint, and we save green capital."

They increase energy use
Electronic technology, like health care, is a resource-intensive field. And while EMR systems may reduce a facility's consumption of one type of resource and production of one type of waste, they substitute others.

"People sometimes have this magical thinking that EMRs have no impact," says Sarah O'Brien, outreach and communications director for the Portland, Ore.-based Green Electronics Council. "But switching media doesn't automatically mean an environmental improvement."

For instance: The server clusters, desktop computers, portable laptops and handheld devices that make up EMR systems require a constant stream of electricity, often produced by coal-fired power plants, in order to operate.

"Energy use is a significant impact of information technology," says Ms. O'Brien. "Carrying over your patient information to EMRs may increase your efficiency, but it will also increase your energy use."

Also, various toxic chemicals and heavy metals are used in the production of computers and electronic components, which present a hazard to their assemblers, to communities and to consumers throughout their use and particularly after their disposal. In recent decades, Ms. O'Brien says, electronics have had a skyrocketing impact on the American waste stream.

The environmental impact of your EMR system as compared to paper records depends on the size of the facility's information technology infrastructure, how efficiently it's used and how conscientiously its components are eventually disposed, all of which require careful analysis. If you're interested in making a positive impact, says Ms. O'Brien, "you have to really look at the system and not just work under the assumption it's going to be better."

Tread lightly
There are several ways to moderate the environmental impact of your technology upgrades. First, says Ms. O'Brien, "integrate green requirements into your purchases. EPEAT makes that easy to do."

EPEAT, the Electronic Product Environmental Assessment Tool, aims to provide criteria you can use to evaluate and compare the sustainability and impact of computers and components. The criteria (available for review at www.epeat.net) include materials selection, energy use, packaging and end-of-life management.

"These qualifications are readily available in base model products," says Ms. O'Brien, noting that it's not more expensive to buy EPEAT-compliant hardware. In fact, their energy efficiency may reduce your expenses over time. Plus, the more that institutional buyers demand EPEAT standards, the more manufacturers will listen.

Health Care Without Harm (www.noharm.org/us/electronics/issue) and the Electronics TakeBack Coalition (www.computertakeback.com) have developed additional purchasing guidelines that extend beyond EPEAT's criteria.

"Green efforts can be delegated to your IT management," says Ms. O'Brien. They should be aware of practices that can reduce your EMR system's impact as well as its cost to your facility. For example, efficient power management, data storage, system cooling and even renewable power sources can help to optimize your network's operations.

Product longevity means less purchasing, and less waste. Maintain your network's hardware for as long as it is functionally practical. Consider identifying potential reuses within your organization, contracting with a third-party service provider to refurbish and resell equipment, or donating the equipment to schools or charities.

If those aren't possibilities, ask the manufacturer about take-back or recycling programs. Integrate end-of-life management into your initial cost analysis, so that when it is time to replace your hardware, it can be disposed of responsibly.