If you work in healthcare, you’ve probably heard some version of: “Climate change is a public health emergency.”
True. Also awkward: healthcare is a notable contributor to the problem it’s trying to treat.
In the United States, the health sector accounts for about 8.5% of national greenhouse gas emissions.
That’s not a typo. That’s “we could be our own small country” territory.
So where do electronic health records (EHRs) come in? Right now, many EHRs excel at the basics:
documenting care, billing accurately, and occasionally reminding everyone that “password123” is not a strong password.
But if we’re serious about decarbonizing healthcare, EHRs can’t stay in the “digital filing cabinet” era.
They need to become active climate toolsnudging smarter care, reducing waste, and helping systems measure what matters.
This isn’t about turning clinicians into carbon accountants. It’s about designing EHR workflows so that
the easiest action is also the lowest-waste actionwhile still being safe, evidence-based, and patient-centered.
The good news: a lot of the levers to reduce emissions already run through the EHR. They’re just not being pulled consistently.
Why climate action belongs in the EHR conversation
Climate change is already driving higher rates of heat illness, worsening air quality, longer allergy seasons, extreme weather injuries,
and infectious disease pattern shifts. At the same time, healthcare’s own emissionsdirect and supply-chainadd fuel to the fire.
The sector is increasingly being asked to track, report, and reduce emissions as part of broader sustainability commitments.
The EHR is the operational nervous system of modern healthcare. If you want to change how care happens at scalewhat gets ordered,
when it gets repeated, how patients travel, how supplies get usedyou inevitably bump into the EHR.
Which means: the EHR isn’t just a passive record of emissions-driving activity. It’s a control panel.
The climate leverage hiding inside everyday EHR clicks
Most healthcare emissions don’t come from one dramatic, villainous machine in the basement labeled “CO2 Generator 3000.”
They come from thousands of ordinary actions repeated every day: extra imaging, unnecessary labs, avoidable admissions,
duplicative paperwork, wasted supplies, and patient travel for short visits that could have been virtual.
EHRs shape those actions by shaping decisions. The moment of orderingtests, imaging, referrals, follow-upsis also the moment when
low-value care can sneak in. Conversely, it’s the moment when the system can help clinicians choose the right thing the first time,
avoid duplication, and coordinate care efficiently.
Interoperability is especially important here. When patient information can’t move reliably between systems, clinicians often repeat tests
“just to be safe,” because reordering is faster than hunting down external results. Better information sharing and interoperability have been
linked to improvements across dimensions of care quality and safetyone of several pathways through which duplication can be reduced.
What EHRs should do to reduce emissions (without compromising care)
1) Reduce duplicate testing by making “find prior results” the default
Duplicate labs and imaging aren’t just costlythey’re carbon-intensive. Diagnostic imaging, in particular, can carry a meaningful footprint,
and reducing unnecessary imaging is a major decarbonization opportunity.
Yet duplication persists because the path of least resistance is too often “order again.”
EHRs can flip that dynamic by making prior results easy to retrieve and trust:
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One-click external results retrieval: If the patient had a CT last week at a different facility, the EHR should surface it
without requiring a scavenger hunt across portals and fax machines. - Clear provenance: Show where the data came from, when it was generated, and whether it’s finalized, so clinicians feel safe using it.
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Duplicate-order “speed bumps”: Not a punishmentjust a quick prompt: “A similar test was performed on DATE at LOCATION. View results?”
If the clinician needs to repeat it, they can. But at least the EHR asked the obvious question out loud. -
Interoperability by design: Support modern exchange standards and align workflows so outside data is actually usable at the point of care,
not buried in a 40-page PDF.
The climate win is straightforward: fewer unnecessary tests means fewer materials, less energy consumption, and less downstream waste.
The clinical win is also big: less patient burden, fewer incidental findings, fewer cascades of follow-up, and more time spent on what actually changes outcomes.
2) Add “carbon-aware” clinical decision supportquietly, respectfully, effectively
Let’s address the fear: clinicians do not want another pop-up. They already have enough alerts to last several lifetimes.
The goal isn’t a loud “THIS CT SCAN IS BAD FOR POLAR BEARS” message.
The goal is subtle, workflow-friendly decision support that helps clinicians choose the right care with less waste.
Practical examples include:
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Imaging appropriateness support: If guidelines suggest ultrasound or X-ray first when clinically appropriate,
the EHR can surface that option earlybefore CT or MRI becomes the default click. -
Low-value care guardrails: If a test is unlikely to change management for a specific scenario, the EHR can offer alternatives:
watchful waiting, a different test, or a shared decision-making script. -
“Carbon label” as optional context: For high-impact choices (like certain imaging pathways),
a small “environmental impact” tag can be visible for teams that opt inespecially in value-based care settings already tracking utilization.
There’s precedent for targeting unnecessary imaging as a sustainability strategy. Research on the carbon footprint of diagnostic imaging highlights
that reducing unnecessary imaging and choosing lower-impact modalities when appropriate are key approaches.
EHR-based decision support is one of the most scalable ways to operationalize that insight.
3) Make telehealth and hybrid care easy when it’s clinically appropriate
Not every visit can be virtual. But many can: medication follow-ups, stable chronic disease check-ins, post-op questions,
behavioral health sessions, and simple triage conversations.
Every avoided drive can reduce emissionsand recent U.S. research has quantified meaningful carbon reductions per telehealth visit by reducing travel.
Here’s how EHRs can push telehealth from “available” to “actually used”:
- Smart scheduling prompts: If the visit type is suitable for telehealth, the scheduler should be nudged toward offering it.
- Integrated patient instructions: Automated tech-check steps, interpreter access, and accessibility toolsbuilt into the workflow.
- Remote monitoring integration: For conditions where home data helps, bring it into the EHR in a usable way (not as a PDF attachment that no one opens).
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Equity safeguards: Build in alternatives for patients with limited broadband, device access, or privacy at home.
Climate solutions that leave people behind aren’t solutionsthey’re paperwork with a green sticker.
When done well, hybrid care can reduce travel-related emissions, lower patient time costs, and improve adherence.
When done poorly, it can increase fragmentation. The EHR’s job is to make the “done well” version the default.
4) Turn the EHR into a sustainability measurement and reporting engine
You can’t manage what you can’t measure, and many health systems are under pressure to track progress on climate goals.
The EHR already contains rich operational data that can support sustainability reportingif it’s structured, accessible, and tied to action.
High-value measurement use cases include:
- Utilization dashboards for high-impact services (imaging, labs, supplies) with clinical context, not just raw counts.
- Preventable duplication metrics by service line, facility, or referral source.
- Care pathway analytics that identify wasteful cascadesmultiple visits for what could have been consolidated.
- Linking procurement and clinical usage (when possible) so supply chain teams and clinicians can co-own sustainability improvements.
The big leap: standardize “environmental impact” as a data layer, just like quality and cost.
That doesn’t mean the EHR becomes a carbon calculator overnight. It means EHRs support the data plumbing so sustainability teams can do credible accounting,
and clinicians can see practical, patient-safe ways to reduce waste.
What EHR vendors must change (because hospitals can’t configure their way out of everything)
Health systems can do a lot with governance, order set redesign, and analytics. But vendors control the architecture.
If we want EHRs to help combat climate change at scale, vendors need to treat sustainability as a core product domainnot a marketing slide.
Build interoperability that actually works in real workflows
True interoperability isn’t just “we can technically exchange data.” It’s “a clinician can retrieve outside results in seconds and trust them.”
Vendors should prioritize robust data exchange, clearer provenance, and better deduplication support, so repeating tests becomes the exception, not the default.
Offer sustainability-ready analytics and APIs
Health systems shouldn’t need a custom data warehouse project to answer basic questions like:
“How many repeat CT scans happened because external results weren’t available?” or
“Which visit types generate the most travel-related emissions?”
Vendors can support standardized reporting and export capabilities so organizations can meet sustainability goals without heroic IT workarounds.
Fix the user experience so “less waste” doesn’t mean “more clicks”
If the sustainable option takes longer, it loses. EHR design should make high-value care fast.
That includes better search, fewer duplicate screens, less redundant documentation, and decision support that helps rather than nags.
(Your clinicians are not ignoring pop-ups because they hate the planet. They’re ignoring pop-ups because they’re trying to finish clinic before midnight.)
What health systems can do right now
Even if your vendor isn’t shipping a “Green Mode” update tomorrow, health systems can start driving EHR-enabled decarbonization today.
Here are pragmatic steps that don’t require a moonshot.
Create a clinical + informatics + sustainability governance group
The most successful efforts bring together:
clinicians (workflow reality), informatics (build and governance), quality leaders (metrics and safety), and sustainability teams (emissions strategy).
Make it a standing group with authority to change order sets and measure impact.
Target high-impact, high-duplication areas first
Start where you’ll see results:
- Imaging pathways with frequent repeats (ED, transfers, pre-op).
- Common lab panels with habitual over-ordering.
- Follow-up visits that could be hybrid or virtual.
- Documentation workflows that generate busywork without clinical benefit.
Redesign order sets with “right care, right time” as the mission
This is where climate and quality align beautifully. Reducing low-value care reduces emissions and improves patient experience.
Use evidence-based guidelines, embed alternatives, and monitor for unintended consequences.
Measure, share, iterate
Publish internal dashboards. Celebrate teams that reduce duplication while maintaining outcomes.
And keep the tone constructivenobody wants to be told they’re “bad” for ordering a test that felt clinically necessary.
The target is system design, not individual blame.
Yes, digital tools have a footprint too (so let’s be smart about it)
It would be ironic if we reduced patient travel but quietly doubled emissions by running bloated software in inefficient data centers.
Digital health has its own carbon footprint, and the evidence base emphasizes the need for robust frameworks to assess it.
That said, well-designed digital interventionsespecially telehealthcan create net emissions reductions when they replace travel and reduce waste.
Practical “green IT” moves include:
- Right-sizing data retention: Keep what’s clinically and legally necessary, but avoid infinite duplication of images and files across systems.
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Efficient cloud and infrastructure choices: Many organizations are evaluating cloud strategies and data center efficiency as part of sustainability efforts.
The key is to demand transparency on energy sources and efficiency. - Software efficiency: Vendors should optimize code and workflows so the system isn’t doing heavyweight computation for trivial tasks.
Bottom line: the “digital footprint” conversation should be a reason to build better, not a reason to do nothing.
In climate work, perfection is the enemy of progressand also, it tends to be very busy posting on Slack.
The bigger picture: policy momentum is rising
Federal and sector-wide initiatives are pushing healthcare toward emissions reduction and climate resilience.
Large organizations have publicly pledged to cut emissions significantly over the next decade, and health systems are increasingly expected
to show credible strategies and progress.
In that environment, EHRs that can support measurement, reporting, and smarter care delivery become a strategic advantagenot a “nice to have.”
Conclusion: EHRs can’t solve climate change, but they can stop making it harder
No one is claiming the EHR will single-handedly reverse global warming. But it can absolutely reduce waste at scale:
fewer duplicate tests, smarter imaging choices, more appropriate telehealth, and better sustainability reporting.
Those are meaningful winsclinically, financially, and environmentally.
The healthcare sector has a duty to protect health. In the climate era, that duty includes reducing the harm we indirectly create.
EHRs sit at the intersection of decisions, data, and operations. If they do morethoughtfully, quietly, effectivelythey can help healthcare
move from “treating climate impacts” to “treating climate causes,” one better workflow at a time.
Experience stories from the field (realistic, relatable, and worth stealing)
I don’t have personal lived experience, but I can share composite “from-the-front-lines” scenarios based on common patterns reported by clinicians,
informatics teams, and sustainability leadersbecause if you’ve seen one EHR workflow, you’ve seen… well, at least three versions of the same problem.
Here are practical experiences that show what “EHRs must do more” looks like in real life.
Experience #1: The Case of the Repeated CT (and the missing outside result)
A hospital noticed a steady stream of repeated CT scans for transferred patients. Clinicians weren’t ordering repeats because they loved radiation
or hated budgetsthey were ordering repeats because the outside images arrived late, in weird formats, or buried in a portal no one had time to open.
The informatics team worked with radiology to build a “prior imaging check” panel that surfaced recent imaging from connected facilities,
showed the timestamp and facility, and offered a one-click “request image transfer” workflow. They also added a gentle prompt when a similar CT had been
performed within a recent time window. The result wasn’t magicalsome repeats still happenedbut the easy repeats dropped, clinician frustration improved,
and patients spent less time doing the “healthcare déjà vu” routine.
Experience #2: Telehealth that actually reduced travel (because the EHR made it easy)
Another health system wanted more virtual follow-ups for stable chronic disease visits. The barrier wasn’t clinician skepticism; it was logistics.
Scheduling staff had to pick visit types manually, patients didn’t always receive clear instructions, and clinicians had to jump between tools.
The fix was almost boring: the EHR began recommending telehealth for specific visit types, automatically sent tech-check instructions,
and embedded interpreter and accessibility options in the standard workflow. Clinicians reported fewer no-shows, patients saved hours of commuting,
and leadership could credibly estimate avoided travel emissions using appointment data. Climate benefits showed up as a side effect of
“we finally made the process not annoying.”
Experience #3: A “carbon receipt” that didn’t shame anyone
A sustainability team partnered with clinical leaders to pilot an optional “environmental context” view for a handful of high-impact services.
Instead of throwing pop-ups at clinicians, they added a small, non-intrusive information tag in the ordering screen for certain imaging pathways.
Clicking the tag opened a short explainer: how emissions vary by modality, when lower-impact options may be clinically appropriate,
and where to find decision support. The surprise? Clinicians didn’t revolt. Many appreciated having the information available for
shared decision-makingespecially when two options were clinically comparable. It wasn’t about guilt; it was about transparency.
Like a nutrition label, but for workflows.
Experience #4: The dashboard that made the CFO and the CMO agree (briefly)
A health system built a utilization dashboard that tracked repeat lab panels, repeat imaging within short windows, and visit types suitable for hybrid care.
They paired it with a “quality safety check” layer to ensure reductions didn’t harm outcomes (no increase in missed diagnoses, no spike in readmissions).
Service lines could see where duplication was happening and why: missing outside results, auto-selected order sets, or unclear follow-up pathways.
Teams tested small changesreordered default options, simplified retrieving outside records, and tuned decision support to reduce noise.
The result was a rare moment of harmony: quality improved, costs dropped, and the organization could plausibly argue it had reduced waste-related emissions.
For about five minutes, everyone liked the same dashboard. That’s basically a miracle.
