Sustainable Tourism Through Telemedicine and Digital Health Services: Environmental Impact Assessment and CO2 reduction Strategies.

Background: The convergence of digital health technologies and sustainable tourism represents a critical opportunity for environmental impact reduction in the 21st century. This systematic literature review examines how telemedicine and digital health services can drive sustainable tourism development while significantly reducing CO₂ emissions. Objective: To evaluate the environmental impact of telemedicine services on sustainable tourism, with particular focus on CO₂ reduction through analysis of international studies, European initiatives, and the Italian experience, highlighting the Puglia COReHealth model as a replicable excellence. Methods: Systematic literature review following PRISMA guidelines across multiple databases covering 2015-2025. Search terms included telemedicine, sustainable tourism, environmental impact, and CO₂ reduction. Data extraction focused on quantitative environmental metrics and sustainability indicators.