Online portal messages sent to healthcare providers more than doubled between 2020 and 2025 as patients gained direct access to their doctors. But rather than replacing face-to-face care, digital medicine is increasing the burden on clinicians without a corresponding reduction in visits, a new study finds.
At least 12% of Americans now communicate with their health care providers about appointments, test results, and ongoing treatment through secure online patient portals or health apps, according to a study led by researchers at New York University Langone Health and published online today in the Journal of the American Medical Association (JAMA).
Online portal messages grew by 153% from 2020 to 2025, from an average of 2.2 messages per year in early 2020 to 5.4 messages per year in late 2025. However, these digital messages do not replace office visits, which are back to an average of two to three per patient per year. During the study period, the number of in-person patient visits increased slightly by 17%, from 2.37 to 2.77 visits per patient per year.
In contrast, the total number of calls decreased by 6% over the same period.
“Our study shows that the use of patient portals, medical apps, and messaging is now part of routine patient care across the United States, rather than an occasional side channel,” said Michal A. Mankowski, Ph.D., principal investigator of the study and assistant professor of surgery at New York University’s Grossman School of Medicine.
Researchers say this is the largest study ever conducted on communications recorded by Epic’s electronic medical records. The team’s analysis included more than 140 million patient records from 2,067 hospitals and 47,100 clinics in the United States, and as part of the study, researchers evaluated more than 8 billion patient-provider interactions from January 2020 to December 2025.
The number of Americans with active health records on Epic grew from 94 million in 2020 to 140 million in 2025. Over the past five years, there were 1.77 billion office visits, 1.59 billion phone calls, and 146 million virtual telehealth portal visits, according to Epic EHR data. Patients sent 1.34 billion messages to health care providers and received approximately 3.25 billion online portal messages from health care providers.
“The big message from our paper is that we felt there was a hypothesis that with the increase in portal messaging, patients interacting with clinicians via encrypted messages, there would be fewer office visits and fewer in-person visits, but that doesn’t seem to be the case. This seems to be a new modality that not only patients, but health systems and providers, have to embrace and prepare for,” Mankowski said at a press conference Monday.
The study found that in the first three months of 2025, 30% of Epic’s active patients (approximately 42 million patients) sent a portal medical app message to a clinician.
“Our findings reveal that while digital medical tools are at the core of healthcare, healthcare delivery is becoming more continuous and timeless, no longer tied to scheduled appointments during daily business hours,” Mankowski said.
Messaging options in digital health apps and portals have made it easier for patients to communicate with their healthcare providers, but researchers say these changes are impacting staffing, workflow, and reimbursement.
Digital delivery of care is adding more steps to existing provider workflows, said study co-investigator Dori L. Segev, MD. To deal with this new patient reality, hospitals, clinics and health care providers need to plan for future staffing and support, said Segev, professor and associate dean of surgery at New York University’s Grossman School of Medicine.
“Modern healthcare delivery increasingly means that healthcare providers must balance digital workloads in addition to traditional clinical workloads,” said Segev, who is also a professor in New York University’s Grossman College of Population Health. “Clinical staff will need training to master healthcare messaging tools, use AI support programs such as chatbots that can minimize content complexity, and make the most effective use of clinician time needed for online billing and online counseling.”
NYU Langone is using AI support tools to speed up the creation of physician and provider notes, Segev said.
Health systems and practices are also grappling with a new digital layer running parallel to traditional health systems. Wearable devices, virtual care platforms, and AI-powered healthcare chatbots offer an “always-on” alternative to episodic care.
“We’re seeing a trend where health care becomes more continuous through smartphones. This is certainly a new change. For years, health care has been episodic from office visit to office visit, and this is an exciting change. There are opportunities, but there are also challenges,” Mankowski said in a briefing.
“More data also means more strain on the health system,” he noted. “We can give you all this data, but this data needs to be analyzed.” This opens up the possibility of using artificial intelligence tools to analyze patient-generated data and messages.
The researchers also looked at which patients sent the most portal messages. Based on data from Q1 2025, the majority of message senders (86%) lived in urban areas and 61% were women. A slightly more third (36%) were between the ages of 40 and 64, and 21% lived in the most vulnerable areas. Social vulnerability is based on the Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index, which takes into account socioeconomic status, household characteristics, racial and ethnic minority status, housing type, and transportation.
The study found that approximately one in four patients in the most vulnerable areas used messaging, compared to one in three patients in the most vulnerable areas. The researchers noted that low use of portal messaging among patients living in socially vulnerable areas could widen existing access gaps.
“Disparities exist among more vulnerable populations, and it is important for our health care system to address these disparities,” Mankowski told reporters. “This is just a descriptive study with no causality established and needs to be looked at further, but again, this appears to be the first evidence at a very national level.”
Healthcare provider organizations should consider a team-based approach among clinicians, staff, and leaders to determine the best way to reach patients, Jane Long, MD, the study’s principal investigator and a resident in the Department of Surgery at New York University’s Grossman School of Medicine, told reporters at a press conference.
“Messaging doesn’t necessarily automatically mean that everyone is connected. Some people are not connected, and some people are texting as often as others. Organizations need to consider this increase in volume, but they also need to think about and be more deliberate about who is not being cared for due to these changes,” Long said.
“This was our first study because there is a lot of detailed data that we can look into further,” she added.
For this study, the team used Epic Cosmos, a national dataset of electronic medical records of more than 300 million American patients. The dataset includes information from the majority of hospitals and clinics that use Epic but were not involved in conducting the study.
While there have been previous single-center studies examining patient messages, Mankowski said using Epic’s database for the JAMA study provides a national picture of patient communication.
Future research will look more closely at message characteristics, response times, and the impact on providers, he said.
Segev said researchers will next look more specifically at trends in digital usage within health systems, including NYU Langone, and analyze regional and outpatient clinic-specific changes that may impact operational plans.
