Patient Portal Messaging Surges 153% Since 2020, Reshaping US Healthcare Delivery

A sweeping new analysis of electronic health record data published in JAMA reveals that patient portal messaging has become a routine, embedded component of American healthcare, with patient-authored messages to clinicians surging 153% between 2020 and 2025. The study, led by researchers at NYU Langone HealthView company profile, represents the largest review ever conducted on communications recorded by Epic electronic health records, encompassing more than 140 million patient records from 2,067 hospitals and 47,100 health clinics across the United States.

The research team evaluated over 8 billion patient-provider interactions spanning January 2020 through December 2025, drawing from the Epic Cosmos national dataset, which includes information from more than 300 million American patients.

"Patient portal messages more than doubled between 2020 and 2025 (by 153 percent). By contrast, total telephone calls decreased by 6 percent over the same period," the study found. The number of Americans with an active Epic health record grew from 94 million in 2020 to 140 million in 2025, and 30% of active patients on Epic—approximately 42 million individuals—sent a portal health app message to their clinician during the first three months of 2025.

Digital communication supplements, not replaces, in-person care

A central finding of the study is that digital medicine is expanding the volume of between-visit care rather than substituting for traditional office visits. In-person visits have rebounded to an average of between two and three per year per patient, while office visits overall rose 17% during the study period. Messages from patients to healthcare providers increased from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025.

"Our study shows that use of patient portals, health apps, and messaging are now a routine part of everyday patient care across America, not simply side channels used occasionally," said Michal A. Mankowski, PhD, study senior investigator and assistant professor in the Department of Surgery at NYU Grossman School of Medicine.

Dr. Mankowski further noted, "Our findings reveal that while digital health tools have become a core part of healthcare, delivery is becoming more continuous, timeless, and no longer tied to scheduled appointments during routine work hours."

The scale of digital healthcare interactions

The study documented the sheer volume of healthcare communications logged in Epic record systems since 2020: at least 1.77 billion in-person visits to health clinics, 1.34 billion messages sent by patients to their healthcare providers, approximately 3.25 billion online portal messages received from providers, 1.59 billion telephone calls, and 146 million virtual telehealth portal visits.

Clinician-authored messages also rose during the study period, increasing 24% from 4.59 to 5.7 messages per patient per year. Messaging intensity peaked during the height of the pandemic in 2021, when volume more than doubled.

"The COVID-19 pandemic marked an early peak in telephone encounters and clinician- and staff-authored messages that only partially normalized, whereas patient-authored messaging increased gradually, indicating a structural shift in communication rather than a transient disruption," the researchers wrote.

Implications for provider workload and health system operations

The growing digital workload presents significant operational challenges. Dorry L. Segev, MD, PhD, study co-investigator and professor and vice chair in the Department of Surgery at NYU Grossman School of Medicine, emphasized that digital delivery of healthcare "does not replace the old ways of working; it just adds another layer of more steps to existing workflows."

"Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload," said Dr. Segev, who is also a professor in NYU Grossman's Department of Population Health. He stressed that clinical staff will need training in mastering messaging tools, using AI support programs—including chatbots that can frame content to minimize complexity—and making effective use of clinician time for online billing and counseling.

The study noted that NYU Langone already uses AI support tools to speed up drafting of physician and provider notes. Researchers also highlighted that health systems may need to plan not only for increased messaging volume but also for addressing engagement gaps among underserved populations, as messaging was most common among women, patients between ages 40 and 64, and those living in neighborhoods with limited social vulnerabilities.

Study methodology and next steps

The research team utilized Epic Cosmos, a national dataset encompassing electronic health records from a majority of hospitals and clinics using Epic, the nation's largest EHR vendor. Epic had no role in performing the study. Funding was provided by NYU Langone.

Dr. Segev indicated the team next plans to examine digital-use trends within specific healthcare systems, including NYU Langone, to identify regional and outpatient clinic-specific shifts that could affect operational planning.

Along with Drs. Mankowski and Segev, NYU Langone researchers involved in the study included lead investigator Jane J. Long, MD, and co-investigators Mara A. McAdams DeMarco, PhD; Mark D. Schwartz, MD; Joshua Chodosh, MD; and Eric K. Oermann, MD.