Illustration by Jon Krause after Henri Rousseau
Since he was a teenager, Daniel Wolk, MD, a family physician in the suburbs of Philadelphia, has had a passion for protecting the environment. Now that he is physician, he sees energy conservation as a key component to patient care.
"My driving philosophy is that my patients will be most healthy when they have a healthy environment to live in. So I feel as a physician I have a role in helping to make that happen," he said.
Dr. Wolk has implemented behind-the-scenes initiatives aimed at cutting the amount of waste at his practice. This includes reducing wasted energy by adopting certain habits with technology use. His practice unplugs chargers when the devices aren't in use and sets computers to go to sleep after a period of inactivity, shutting them down completely at night. His practice uses recycled computer equipment. He has found that each step is small when measured alone, but that they add up to more significant results environmentally and financially.
Christina Vernon, an architect who leads the Office for a Healthy Environment at the Cleveland Clinic, said most people think of construction as the only opportunity to "go green." But green initiatives have as much to do with the way a practice operates as they do the materials used to construct the building that houses the practice. A large component is the technology used to run the practice.
"Practices will become environmentally friendly the moment they implement an [electronic medical record] system," said Barry Haitoff, CEO of Medical Management Corp. of America. Going electronic will significantly reduce the tons of paper typically used by most physician practices, he said.
But practices can take it a step further and look at the energy consumed by the technology it adopts. So it's not just about going electronic, but also about choosing the right computer equipment and the most eco-responsible vendors, training office staff on best practices, and knowing what to do with electronic equipment when it's ready to be discarded.
Decisions that have low impact on the environment also affect the bottom line, experts say.
Dr. Wolk sees another difference in addition to the energy he saves by running a "green" practice -- the hundreds of dollars shaved off his utility bills each month. His advice to physicians starting green initiatives: "Look at what's called the triple bottom line. That means not only the profit and costs of how you're setting up your practice as a business, but also looking at the environmental costs and the benefits of the choices you're making and also how they're interacting with your monetary bottom line," he said.
"Power savings will ultimately lead to money savings."
Buying greenWhether a physician office has a full-blown EMR or a practice management system, it's likely that the office has at least one computer in its inventory. When purchasing computers, the easiest thing to do is to look for the Energy Star label.
Energy Star is a joint program of the U.S. Environmental Protection Agency and the U.S. Dept. of Energy focused on energy conservation. It evaluates products for energy efficiency, and those with low emissions are given an Energy Star label. The Energy Star is the most widely recognized label in the U.S. Other countries use their own labeling systems.
Although most mainstream technology companies have taken steps to control energy consumption to earn the Energy Star label, medical device vendors are behind in that area.
There is no Energy Star equivalent for the medical device industry, but that doesn't mean it has to remain that way. Asking the right questions during the procurement process will help physicians understand the environmental impact of new technology. It also will put pressure on vendors to know the impact and take steps to reduce it, Vernon said.
Neil Rosen, an architect and a member of the U.S. Green Building Council, said during the procurement process practices can require potential vendors of, say, imaging equipment, to prove they are in the top 25% of the most energy-efficient. He said this type of pressure has forced many manufacturers to examine their energy consumption. Many were surprised to learn how much energy they use and started looking for ways to lower it.
Rosen, who is also senior project manager in facilities at North Shore LIJ Health System in New York, said manufacturers are finding ways to cool equipment without using water, a method long used by many imaging devices.
"There's a lot of great questions that we can be asking as buyers, as purchasers of stuff that will put pressure on the industry to have the answers," Vernon said.
Employee engagementVernon said the "biggest missed opportunity" when it comes to green initiatives is engaging the work force. One way to achieve this is with education, she said.
"Individuals in our community and our work force, they get it at home," Vernon said. "They don't walk out the front door leaving all the lights on, the television on, the radio blaring. They understand basic energy conservation practices at home, and we are encouraging them to bring those practices with them to work."
Rosen said a little carrot, as opposed to the stick, goes a long way. Recognition for doing good is something employees respond to, he said. "You have to get them to want to do it, not force them to do it."
Dr. Wolk said most of his practice's green activity is done passively. But he has been known to leave a comical note here and there if he notices lights have been left on after hours.
Rosen said performance-based bonuses can include the practice's carbon footprint, which is easy to track and monitor over time, starting with the utility bills. If the energy consumption is less, the bills will go down.
Practice Greenhealth, a member organization for health care facilities dedicated to an environmentally friendly practice, offers online tools to reduce, manage and measure a facility's carbon footprint. Some tools are free, and others are restricted to members.
There are changes that can be made in the background to help reduce waste.
Computers can be programmed to go to sleep if inactive for more than a few minutes. Shutting computers down completely will save more energy, but if employees routinely walk away and return shortly thereafter, the time it takes to power up each time would be a frustration point most employees won't appreciate, Rosen said. Powering the machines down at night would be more efficient, he said.
There also are power strips equipped with motion detectors that will put devices to sleep when no movement is detected and wake up when someone enters the room.
Office printers present opportunities for conservation, said Meagan Bozeman, who works in Xerox's solid ink sustainability and consumables strategy area. Paper waste can be cut in half by printing on both sides of a sheet of paper.
Bozeman said paper waste has the biggest impact on the environment. To put it into perspective, she quoted EPA figures showing that it takes almost 17 watt hours to produce a single sheet of paper (recycled paper uses 12 watts). A medium-sized copier, which is typical for use in a doctor's office, that produces about 50 copies per hour, uses 17 watts of energy per hour -- the same as producing one sheet of paper.
The type of printer and the ink can make a difference. Laser printers use less energy than ink jet printers. And combination fax, copy and printing machines can reduce energy consumption by 50%, Bozeman said.
Ink cartridges also are a source of waste that can be reduced by behavior modifications. Bozeman said solid ink sticks produce 90% less waste than liquid ink cartridges and cost less to produce, package and deliver.
Life cycle of technologyWhen purchasing new technology, practices need to talk to vendors about the total cost of ownership, which includes a plan for what happens to the product once its life cycle has expired.
Dr. Wolk said his decision to recycle all his old technology not only helps reduce waste but also helps consumers down the chain save money by purchasing refurbished equipment instead of new. He has saved money by buying refurbished equipment.
Vernon said practices should ask vendors about the life cycle of equipment, both IT as well as medical devices. Questions to ask include how much toxic heavy metal is in the device and how it is recycled when it exceeds its lifespan. The vendor should know how much it will cost to have someone haul away the equipment, how it is recycled, and whether the vendor has product stewardship in place, in which case the vendor would take it back.
The EPA has a list of resources on its website to find a place to donate, recycle or dispose of technology safely.
Dr. Wolk admits that many initiatives have small impacts on their own. But if those little changes are multiplied by millions of people, they could be substantial, he said.
This article was originally posted at http://www.ama-assn.org/amednews/2011/06/06/bisa0606.htm
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