Contributing to environmental sustainability of healthcare systems through Diagnostic Network Optimization

Authors Bios: Gopal Panta is a laboratory science specialist with more than 15 years of experience in laboratory system strengthening, infectious disease control, and quality and safety in healthcare including safe healthcare waste management. He is currently serving as the Regional TB and Infectious Diseases Technical Advisor (Diagnostic Advisor) for Asia-Pacific region within FHI 360. Janet Robinson is an infectious disease, health security, public health, laboratory, health systems strengthening, and regulatory specialist with more than 30 years’ experience in global public health, health security, pandemic preparedness, healthcare programming, health systems strengthening, human and animal health laboratory diagnostics, regulatory affairs/quality assurance and research. She is currently serving as a Portfolio Director within FHI 360’s Infectious Diseases and Health Security Division.

Laboratory diagnostics, a critical component of healthcare systems, have a pivotal role to play in effective treatment and detection of disease. Diagnostics involves the use of specific infrastructure, equipment, chemicals, and biological specimens, all of which can have adverse impacts on the environment through carbon emissions, waste generation, dissemination of toxic chemicals, and environmental contamination. These environmental impacts can be particularly challenging to mitigate in countries with limited resources: for instance, when waste destruction equipment is unaffordable,  laboratory waste is often burned in open spaces or inadequately incinerated, leading to the generation of toxic pollutants such as persistent organic pollutants. In addition, diagnostic systems use significant energy resources, contributing to substantial greenhouse gas emissions. As demand for high-quality diagnostic services increases with the proliferation of emerging infectious diseases, it is critically important to minimize adverse environmental impacts and build robust, environmentally sustainable laboratory systems.  

One important tool that can be harnessed for reducing the environmental impacts of diagnostics is Diagnostic Network Optimization (DNO), which helps to improve efficiency and increase access to diagnostic services. DNO connects diagnostic facilities through a robust specimen referral and network optimization mechanism, utilizing rational spatial distribution and integration of diagnostic services. DNO ultimately promotes rational use of diagnostics, decreases turnaround time for test results, and thus improves timely diagnosis, treatment, and control of diseases.

By rationalizing where diagnostic services are offered and how they are linked through a network of referral facilities, DNO can prevent unnecessary expansion of highly specialized and energy-intensive diagnostic laboratories. Additionally, DNO promotes utilization of a single diagnostic platform for diagnosing multiple diseases, thus minimizing the need for dedicated equipment for individual tests. It also minimizes the need for all facilities to perform all diagnostic tests, facilitating the strategic relocation of equipment within the network. This reduces the requirement to procure additional energy-intensive equipment such as biosafety cabinets, refrigerators/freezers, and autoclaves, which can reduce energy use and optimize resources.

DNO minimizes the need for patient travel by using efficient specimen referral and transportation mechanisms, which ultimately can reduce carbon footprints of diagnostic services.  Centralized testing can also lead to less production of laboratory waste compared with decentralized testing. In addition, DNO supports forecasting, quantification and supply chain management of laboratory reagents and consumables across the network which can avoid excess procurement and waste.

To further reduce environmental harm, laboratories can adopt the reduce, reuse and recycle approach for waste management and replace paper-based information management systems with web-based systems.

Another way diagnostic networks can reduce their environmental footprint is by using the most efficient specimen transportation options. For many places in the developing world, motorbikes are commonly used and provide a quicker means of transportation than cars. Seeing as an average medium-sized motorbike has less direct CO2 emissions than an average petrol van (103.2 vs. 220.2 g per kilometer),  using motorbikes can be a convenient and environmentally friendly option for specimen transportation. Similarly, if reliable public transportation companies are available, these can also be utilized for specimen transportation instead of specifically assigned petroleum vehicles, given that drivers and handlers are appropriately trained in safety measures for biological specimens.   Likewise, electric vehicles could be used for specimen transportation to reduce carbon emissions, depending upon the availability of electric vehicles and feasibility of their use in low-income settings.

DNO can also minimize carbon footprints by choosing reusable products and materials for packaging, storage, cold-chain maintenance, and transportation of biological specimens. Items such as cold-boxes, ice packs, packaging containers, and transportation bags are required in large quantities and can easily be reused after proper disinfection, ensuring that they maintain the ability to comply with UN regulations while reducing the amount of physical materials used. Similarly, laboratory waste management can be standardized across the network, minimizing the carbon footprint and eliminating the release of toxic pollutants.

In this digital era, the use of web-based information systems for prescribing tests, tracking specimens, and recording and reporting test results across the diagnostic network can considerably reduce carbon footprints. Through DNO, web-based laboratory information systems can be integrated and made interoperable with other healthcare information systems, minimizing in-person visits, the need for paper and storage space, transcription errors, and the need for repeated tests.

Diagnostics are the backbone of any healthcare system and are currently drawing enormous attention globally due to their critical role in global health security. At the same time, it is important to ensure that diagnostic services have minimal impact on the environment. DNO can be used to improve accessibility, efficiency, and quality of diagnostic services while contributing to environmental sustainability of healthcare systems and minimizing adverse impacts.