ASF Standards · Telemedicine · Standard 9

Standard 9 — Sustainable Care

5 criteria · 0 core · 5 standard-level · Version 1.0 · Aligned to ISQua EEA Principle 6, 6th Edition

Criteria in this standard

9.1 — Digital Infrastructure Impact Is Genuinely Assessed, Not Assumed Negligible
9.2 — Hosting and Technology Procurement Genuinely Considers Environmental Impact
9.3 — The Provider Genuinely Considers Its Real Reduction of Patient Travel Impact
9.4 — Staff Are Genuinely Engaged in Sustainability Practice
9.5 — Sustainability Commitments Are Genuinely Reviewed, Not Static

9.1

Digital Infrastructure Impact Is Genuinely Assessed, Not Assumed Negligible

Standard

The provider genuinely assesses the environmental impact of its own digital infrastructure — server hosting, data storage, device energy use — not assumed negligible simply because the service has no physical patient-facing facility.

In plain terms: Having no physical clinic doesn’t mean no environmental footprint — servers, data storage, and devices all genuinely use real energy, and the provider has actually looked at this.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A telemedicine provider’s absence of a physical building can create a genuine, mistaken sense that there is no real environmental footprint to consider — but server infrastructure, data centers, and the cumulative device energy use of a distributed clinical workforce all carry real, measurable impact. Digital services aren’t impact-free; their impact is simply less visible.

What good looks like

A genuine assessment of hosting and infrastructure impact exists.
Cloud or hosting provider environmental practice has been genuinely reviewed.
This assessment is genuinely revisited periodically.

Common failure modes

No assessment has ever been conducted, on the assumption a digital service has no real footprint.

Worked example

In practice

A telemedicine provider that had never considered its hosting footprint.

BeforeThe provider used a major cloud hosting service with no review of that provider’s own energy sourcing or environmental commitments.

ActionThe hosting provider’s published sustainability report was reviewed and documented as part of the assessment.

AfterThe Monitor reviewed the documented assessment. Verified.

If you are starting from zero — do this first

Review your hosting provider’s own published environmental practice.

The most common mistake: Assuming a digital-only service has no real environmental footprint worth assessing.

Self-assessment questions

1. Has the provider genuinely assessed its hosting and data infrastructure footprint? — A real, documented assessment.
Evidence: Infrastructure assessment document

2. Where cloud or hosting services are used, has their provider’s own environmental practice been genuinely reviewed? — A real, specific check.
Evidence: Hosting provider review

3. Is this assessment genuinely revisited periodically? — Real, periodic review.
Evidence: Review schedule

Common reasons for a PARTIAL answer

Hosting is used but the provider’s own environmental practice was never checked.

Implementation plan

When	What
Week 1-2	Review hosting provider’s environmental practice and document.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Assessment review	Reviews the documented infrastructure assessment.

Supervisor tips

Ask directly whether anyone has looked at the hosting provider’s own sustainability record.

Evidence base

World Health Organization. WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. Geneva: WHO; 2020.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

9.2

Hosting and Technology Procurement Genuinely Considers Environmental Impact

Standard

Decisions about cloud hosting providers, servers, and core technology infrastructure genuinely factor in environmental impact alongside cost and performance — not sustainability treated as irrelevant to a purely digital service.

In plain terms: When the provider picks a hosting company or technology vendor, it actually considers environmental impact — not purely cost and speed.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Technology procurement decisions — which hosting provider, how data is stored and retained — compound across a provider’s entire operation, and genuine environmental consideration here is where a digital provider’s real sustainability commitment is actually tested, not in a general policy statement.

What good looks like

Hosting decisions genuinely weigh environmental impact.
A real instance shows this influencing a choice.
Data storage is genuinely reviewed for efficiency.

Common failure modes

Hosting is chosen purely on cost and performance.

Worked example

In practice

A provider reviewing its data retention practice.

BeforeAll patient data was retained indefinitely by default, with no review of what was genuinely necessary to keep versus what could be archived or deleted per regulatory requirements.

ActionA data retention policy was introduced aligned with actual regulatory requirements, reducing unnecessary long-term storage.

AfterThe Monitor reviewed the retention policy. Verified.

If you are starting from zero — do this first

Review current data retention practice against actual regulatory requirements.

The most common mistake: Data retained indefinitely by default with no genuine review of what’s actually necessary.

Self-assessment questions

1. Does hosting provider selection genuinely weigh environmental impact? — Real, documented consideration.
Evidence: Procurement criteria

2. Is there a real, documented instance of this genuinely influencing a choice? — A concrete, real example.
Evidence: Procurement decision record

3. Is data storage genuinely reviewed for efficiency? — A real, ongoing review.
Evidence: Retention policy

Common reasons for a PARTIAL answer

A retention policy exists but hasn’t actually been applied to reduce storage.

Implementation plan

When	What
Week 1-2	Review and document a data retention policy.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Procurement review	Reviews procurement criteria and retention policy.

Supervisor tips

Ask about the current data retention policy specifically.

Evidence base

NHS England. Delivering a Net Zero National Health Service. London: NHS England; 2022.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

9.3

The Provider Genuinely Considers Its Real Reduction of Patient Travel Impact

Standard

The provider genuinely recognises and, where meaningful, documents the real environmental benefit telemedicine delivers by reducing patient travel — not an unexamined assumption of benefit with no real attention to whether this is actually communicated or substantiated.

In plain terms: The provider has actually thought about the real environmental benefit of patients not having to travel for care, not just assumed it exists without ever really considering it.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

Telemedicine’s genuine environmental benefit — avoided patient travel — is real and substantial, but it’s also easy to assume without ever actually examining or substantiating it. A provider that genuinely considers this benefit is better positioned to make real, informed decisions about which services should remain available remotely versus which genuinely require in-person delivery.

What good looks like

The real travel-reduction benefit is genuinely recognised.
This benefit is genuinely communicated where appropriate.
This recognition genuinely informs scope decisions.

Common failure modes

The benefit is assumed but never actually examined or communicated.

Worked example

In practice

A provider that had never actually examined its travel-reduction impact.

BeforeThe provider’s marketing mentioned convenience but never genuinely considered or communicated the environmental dimension of avoided travel.

ActionA brief internal review documented the genuine travel-reduction benefit, which informed a decision to keep a specific follow-up service remote rather than reverting to in-person.

AfterThe Monitor reviewed the documented consideration and its connection to the scope decision. Verified.

If you are starting from zero — do this first

Document a genuine consideration of the travel-reduction benefit your service provides.

The most common mistake: Assuming the travel-reduction benefit without ever actually examining or documenting it.

Self-assessment questions

1. Does the provider genuinely recognise telemedicine’s real travel-reduction benefit? — A real, considered recognition.
Evidence: Documented consideration

2. Is this benefit genuinely communicated to patients where appropriate? — Real, visible communication.
Evidence: Patient-facing communication

3. Does this recognition genuinely inform scope decisions? — A real, considered connection.
Evidence: Scope decision record

Common reasons for a PARTIAL answer

The benefit is mentioned in marketing but never genuinely examined internally.

Implementation plan

When	What
Week 1-2	Document a genuine consideration of travel-reduction benefit.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Consideration review	Reviews the documented consideration and any resulting decision.

Supervisor tips

Ask whether this has ever actually informed a real service-scope decision.

Evidence base

World Health Organization. Global Strategy on Digital Health 2020-2025. Geneva: WHO; 2021.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

9.4

Staff Are Genuinely Engaged in Sustainability Practice

Standard

Staff genuinely understand and participate in the provider’s sustainability practices — not a policy known only to leadership with no real staff awareness or input.

In plain terms: Staff actually know what the provider is doing to be more sustainable — including staff who rarely or never meet colleagues in person.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A genuinely distributed, remote workforce can easily miss internal communication that would naturally reach an in-person team through a noticeboard or hallway conversation — genuine sustainability engagement here requires deliberate, functioning communication appropriate to this provider’s actual structure.

What good looks like

Staff can genuinely describe a real practice.
Staff input is genuinely sought.
Communication genuinely reaches remote staff.

Common failure modes

Communication happens only at head office, missing remote staff entirely.

Worked example

In practice

A provider whose sustainability updates never reached remote clinicians.

BeforeSustainability updates were posted on an office noticeboard that remote clinicians never saw.

ActionUpdates were moved to the provider’s standard internal digital communication channel, genuinely reaching all staff.

AfterThe Monitor interviewed a remote clinician who could describe a recent update. Verified.

If you are starting from zero — do this first

Check whether current communication genuinely reaches remote staff, not just those at a central office.

The most common mistake: Internal communication methods designed around an in-person office that a genuinely remote workforce never sees.

Self-assessment questions

1. Can staff describe a genuine sustainability practice? — Real, demonstrated awareness.
Evidence: Staff interview

2. Is staff input genuinely sought? — Real, two-way engagement.
Evidence: Staff suggestion record

3. Does communication genuinely reach remote or distributed staff? — Real, functioning communication.
Evidence: Remote staff interview

Common reasons for a PARTIAL answer

Office-based staff are aware but remote staff genuinely are not.

Implementation plan

When	What
Week 1	Move communication to a channel that genuinely reaches remote staff.

How the Monitor verifies this

Method	What	Detail
ASK	Staff interview	Asks a remote staff member to describe a specific practice.

Supervisor tips

Interview a genuinely remote staff member, not only office-based staff.

Evidence base

Health Care Without Harm. Global Green and Healthy Hospitals Agenda. Reston: HCWH; 2020.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

9.5

Sustainability Commitments Are Genuinely Reviewed, Not Static

Standard

The provider’s sustainability goals and practices are genuinely reviewed and updated as circumstances change — not a document written once and never genuinely examined for whether it still reflects actual practice.

In plain terms: The provider’s sustainability goals actually get revisited — not written once and left to go stale.

Facility category	Crisis	Transition	Small	Standard
Applicability	Adapted	Full	Full	Full

Why this matters

A document written once stops genuinely reflecting current practice as hosting providers, data practices, and the provider’s own scale change. Real, periodic review is what keeps the commitment meaningful.

What good looks like

Goals are genuinely reviewed.
A real revision instance exists.
Responsibility is genuinely assigned.

Common failure modes

A document was written once and never revisited.

Worked example

In practice

A provider whose sustainability statement predated a hosting provider switch.

BeforeThe statement referenced a hosting provider no longer used.

ActionA named person was assigned annual review responsibility.

AfterThe Monitor reviewed the updated, dated document. Verified.

If you are starting from zero — do this first

Assign named review responsibility.

The most common mistake: A document nobody is specifically responsible for revisiting.

Self-assessment questions

1. Are goals genuinely reviewed? — A real, periodic review.
Evidence: Review schedule

2. Is there a real revision instance? — A concrete example.
Evidence: Revision history

3. Is responsibility genuinely assigned? — A real, named accountability.
Evidence: Assigned responsibility documentation

Common reasons for a PARTIAL answer

A schedule exists but hasn’t been followed consistently.

Implementation plan

When	What
Week 1	Assign review responsibility and conduct the first review.

How the Monitor verifies this

Method	What	Detail
DOCUMENT	Revision history review	Reviews the document’s revision history.

Supervisor tips

Ask who is specifically responsible for review.

Evidence base

United Nations Environment Programme. Sustainable Healthcare Facilities Guidance. Nairobi: UNEP; 2022.

ASF training courses on GMJ Academy →

Foundation courses A-00 to A-03 are live. Criterion-specific modules are being developed and will link here when published.

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