As physicians, nothing brightens our faces quite like shutting off our computers. We spend almost two hours of every work day wrestling with the long loading times to view clinical data, the litany of structured data sets we must complete to meet medical billing requirements for innumerable insurance companies, and the nearly endless sea of protected health information we must wade through just to find the piece we need for our patients.
Ask anyone in this field: The amount of digitalized data in health care alone is staggering. From clinical notes to laboratory results to radiologic images, the types and quantities of medical data are myriad. According to a 2019 report from the World Economic Forum, the average hospital produces approximately 50 petabytes of data per year, with 97% of the data going unused. To put that enormous number in perspective, this is the equivalent of streaming a two-hour movie about 25 million times annually. Multiply that number by the over 6,000 hospitals in the United States, and the amount of data becomes incomprehensibly large. And that report was from five years ago — the numbers are likely even higher now!
For some time now, health care professionals and stakeholders have rightfully pointed out the human capital erosion associated with the burden of near-constant documentation and production of digital data. However, as physicians in New Mexico, we have been considering a different question: What are the environmental implications of this mass health care data storage?
In various engineering and computer science circles, the terms “dark data” and “digital waste” have emerged to describe the vast majority of digitalized data saved and stored in clouds and servers that end users never access again. The process of uploading and storing data requires a tremendous amount of electricity. Based on carbon dioxide production per unit of electricity estimates from the Environmental Protection Agency, some experts have stated that storing 100 gigabytes of data — about the size of many modern hard drives — in the cloud over a year would produce 0.2 tons of carbon dioxide. By this logic, a typical hospital in the United States employing a similar storage strategy would have a carbon footprint of 100,000 tons from its digital data storage alone. Furthermore, this would mean that digital waste would be responsible for 97,000 tons of the carbon dioxide produced. The U.S. health care sector is responsible for over 8% of the country’s carbon emissions annually, yet many estimates don’t factor the toll of digital waste into the carbon footprint.
It’s easy to conceptualize waste as tangible things: trash bags littering a landfill, disused vehicles lining a salvage yard, or unclaimed newspapers filling a shredding receptacle. But it can be harder to wrap the mind around the possibility of intangible things like dark data to be waste. But just as physical waste must be stored in places prior to destruction or other forms of processing, most data must be stored in specialized facilities called data centers for future access. In these facilities, many pieces of hardware are used for data storage, requiring regular maintenance to protect the stored data. Although digital data may exist almost ethereally in a virtual cloud, the equipment in which the data are stored and maintained is all very much real.
The key to efficient data retrieval for health care professionals is proper maintenance of data storage facilities, which requires a mammoth amount of energy. According to the United States Department of Energy, most energy-intensive building types consume 10 to 50 times the energy per floor space of a typical commercial office building. Among these highly energy-intensive buildings, data centers require around-the-clock maintenance and preventive measures to ensure their continued functionality. Basic upkeep tasks for these facilities include cleaning, inspecting software and hardware, and regulating environmental conditions. An oft-overlooked aspect of data storage is real-time cybersecurity monitoring, which necessitates having staff and resources available at all hours to address problems swiftly should they arise.
Unsurprisingly, operating a data storage facility is extremely resource-intensive and has a carbon footprint beyond the data storage itself. Some companies’ data centers are being submerged in oceans and other large bodies of water for purported sustainable cooling. However, there are concerns that these centers could contribute to oceanic warming, especially if placed underwater in large numbers.
Nobody can argue that ready access to health-related data benefits patients, health care professionals, clinics, hospitals, and entire health systems. Having access to the right information at the right time can be instrumental in diagnostic accuracy, timely care, and optimal medical decision-making. However, apart from excessive energy consumption and unsustainable carbon emissions, maintaining massive amounts of digital data comes with unique challenges, including security, privacy, and the production of environmentally harmful solid waste. Beyond the environmental implications of mass data storage alone, it is worth considering what it means to create electronic devices to perform this function, which often become obsolete not too long after creation and require replacement.
Electronic waste, also known as “e-waste,” is considered hazardous and a threat to public health and safety, especially when disposed of inappropriately. Sixty different types of metals, including copper, gold, silver, palladium, aluminum, and iron, are used to make all of these technological products frequently used for data storage. As many would surmise, these components do not degrade significantly over time, meaning they become a mostly permanent aspect of our world once discarded. In addition, these electronics often contain harmful chemicals like mercury, lead, and halogenated flame retardants that end up in landfills alongside other nonbiodegradable waste, eventually threatening humans and animals with critical and unsustainable levels of pollution.
With the relentless growth of health care data in electronic health records worldwide, we as a health care community must take substantive steps toward preventing the environmental damage caused by massive data storage and management. We must work collaboratively as a global community for better health outcomes everywhere. Unbeknownst to many of us, our current practices are likely causing far-reaching harms that fly freely under our radars because they are supposedly better than the old practices. In the 2019 report “Health Care’s Climate Footprint,” authors from Health Care Without Harm in collaboration with Arup write that the global health sector would be the fifth-largest carbon emitter on the planet if it were a country and that the United States alone accounts for over a quarter of the global health care carbon footprint. Based on these statements, we have an ethical responsibility to ascertain what we are actually gaining from our unscalable mountains of digitalized health care data versus what we stand to lose if we continue on this path.
Ashten Duncan, M.D., M.P.H., C.P.H., is a board-certified family physician working as core faculty of the Medicos de El Centro Family Medicine Residency in Espanola, New Mexico. Khuzeman Abbasi, M.D., and Sana Augustine, M.D., are first-year family medicine resident physicians in the same residency program.