Telemedicine for innovation and sustainability: Social life cycle assessment (S-LCA) from the healthcare system perspective

Telemedicine has rapidly transitioned from a peripheral innovation to a structural component of contemporary healthcare systems, particularly in the wake of the coronavirus disease 2019 pandemic. Although its environmental and clinical benefits have been extensively documented, its social sustainability impacts remain significantly underexplored, especially for internal stakeholders, including clinicians, administrative staff, caregivers, and the surrounding community. This study responds to this gap by applying the new ISO 14075:2024 standard for Social Life Cycle Assessment (S-LCA) to a real-world telemedicine program implemented at ASST Bergamo Est, one of the most advanced public healthcare organizations in Lombardy, Italy. We operationalized ISO 14075 using a performance-based Social Life Cycle Performance Assessment (S-LCPA), integrating organizational records, staff interviews, user data, regional statistics, and peer-reviewed telemedicine evidence-derived qualitative, semiquantitative, and quantitative indicators. Six social impact categories, including access to care, quality of life and well-being, working conditions, community development, privacy and data security, and ethics and responsible innovation, were evaluated across four stakeholder groups: patients and caregivers, healthcare professionals, the healthcare organization, and the local community. To structure the assessment, we developed five-level Performance Reference Points (PRPs) consistent with ISO 14075 and the Subcategory Assessment Method. Results revealed high institutional maturity in organizational governance, data protection, and the structural integration of telemedicine across multiple specialties (PRPs 3–4). However, several domains, including digital inclusion (PRP 2), community-level co-benefits (PRP 2), and patient-reported outcome measures (PROMs) (e.g., comfort, therapeutic adherence, and satisfaction [PRP 1]), remained underdeveloped. These asymmetries reflect broader patterns in the telemedicine sustainability literature, where governance infrastructures advance faster than the systematic measurement of social outcomes. The findings demonstrate that ISO 14075 can be operationalized in a complex healthcare service and provide a replicable model for organizational S-LCA in digital health. This study concludes with methodological recommendations, including the significance of telemedicine-specific PROMs, routine digital inclusion metrics, and integration of S-LCA within regional planning and quality-improvement frameworks. As telemedicine becomes embedded in hybrid models of care, social sustainability assessment is crucial for supporting more equitable, ethical, and socially resilient digital transformation.