Accelerating sustainability transitions in care and health systems: How sustainable are e/m-Care and Health innovations?

Electronic and mobile healthcare services (e/mCare&Health) relying on information and communication technology such as computers and mobile phones are increasingly becoming standard for care and disease prevention or management. With new virus outbreaks, e/m-Care&Health has gained momentum and becomes a major instrument for enhancing sustainability in health systems. However, improving truly healthcare while addressing both current ecological challenges such as the finite nature of resources, greenhouse-gas (GHG) emission reduction targets, and social challenges such as health inequities, system innovations should differ substantially from mainstream (technical and product-driven) innovations. To date, very few authors investigated how the environment could be integrated into the various assessment methods of care and health technology, considering that the healthcare sector itself generates significant environment impacts including GHG emissions, air pollution, and plastic and pharmaceutical waste. The question if and to what extent current e/m-Care&Health innovations are positioning care and health systems on a more sustainable trajectory remains unclear, as are the dimensions that define sustainable innovations and sustainability transitions in care and health systems. An in-depth understanding of the sustainability of e/m-Care&Health innovations is essential to unleash their ability to provide a systemic solution for charting a sustainable path forward. This calls for looking beyond the technicalities of e/m-Care&Health innovations and studying work and business model issues, environmental aspects, users’ position within health systems as well as health policies themselves. This paper reflects on the evaluation of e/m-Care&Health solutions beyond their clinical efficiency and potential cost savings. Using literature review and borrowing an interdisciplinary dialogue, this paper examines four specific dimensions of e/m-Care&Health innovations that relate to their sustainability: (i) the features of innovative organizational models (for-profit and not-for-profit) via Socio-Economics, (ii) the behaviors and attitudes of end-users (i.e., patients and/or caregivers) toward e/m-Care&Health innovations from a Human-Computer Interaction perspective, (iii) the effectiveness and cost-effectiveness of these innovations using an Health Economics approach, and (iv) the evaluation of the environmental footprint through life-cycle analysis from an Information and Communication Technology perspective. We emphasize the meaning of sustainability in each of these disciplines perspective and provocatively discuss how the current evaluation of e/m-Care&Health innovations is oversimplified and does not grasp the essence of sustainable transitions in health systems