Critical review of environmental impact evaluations of electronic healthcare devices: challenges and recommendations

There has been a recent proliferation of electronic healthcare devices (EHDs); however, their environmental impacts are not yet fully understood. EHDs have direct environmental impacts attributed to the life cycle stages including raw material extraction, manufacturing, distribution, use, and end-of-life (EOL). In addition to the direct impacts, there are indirect impacts that arise from the use of these devices such as favourable effects on the optimization of healthcare procedures and adverse impacts arising from the additional demand for resources. This critical review aimed to gain insight into the state of the art of environmental impact assessments of EHDs, after which challenges were identified and recommendations provided to move towards comprehensive environmental sustainability assessments. The literature review relied on three databases (PubMED, Scopus, and Embase) and specific screening steps, resulting in 17 articles, ten of which applied life cycle assessment. This paper identified methodological challenges in the selected studies and lack of consistency in evaluating the environmental impacts of EHDs. For example, seven studies used device-oriented FU, while others applied a treatment-oriented FU, however, all of which aim to investigate the environmental performance of EHDs. These inconsistencies between studies make it hard to understand the environmental sustainability of EHDs. Moreover, the impacts of these devices are mostly considered at the product level and overlook potential indirect impacts associated with the healthcare value delivered by the EHDs (e.g. fewer hospital bed days). It is important to consider a wider boundary of healthcare pathway rather than the narrow boundary of the device. This will involve considering both the direct life cycle impacts of the device (e.g. impacts related to production or end-of-life) and the positive and negative effects of using the EHDs at the healthcare pathway level. This would result in comprehensive environmental sustainability assessments of EHDs from a healthcare perspective.