Online portal messages sent to providers more than doubled between 2020 and 2025 as patients now have much more direct access to physicians. But there hasn't been a corresponding drop-off in clinic visits as digital medicine is adding to clinicians' workload rather than replacing in-person care, a new study finds.
At least 12% of Americans now communicate with their healthcare providers about appointments, test results and ongoing treatments via secure online patient portals and health apps, according to a study led by researchers at NYU Langone Health and published today in the Journal of the American Medical Association (JAMA) online.
Online portal messages jumped 153% from 2020 to 2025, from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025. But these digital messages are not replacing in-office visits, which have returned to an average of between two and three per year per patient. In-person office visits saw a modest 17% increase, going from 2.37 to 2.77 per patient per year, during the study period.
By contrast, total telephone calls decreased by 6% over the same period.
"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 study senior investigator Michal A. Mankowski, Ph.D., an assistant professor in the Department of Surgery at NYU Grossman School of Medicine.
Researchers say it represents the largest review ever performed on communications recorded by Epic electronic health records. The team’s analysis involved more than 140 million patient records from 2,067 hospitals and 47,100 health clinics in the U.S. As part of the study, the researchers evaluated over 8 billion patient-provider interactions that took place between January 2020 and December 2025.
The number of Americans with an active Epic health record went from 94 million in 2020 to 140 million in 2025. Over that five-year period, according to Epic EHR data, there were 1.77 billion office visits, 1.59 billion telephone calls and 146 million virtual telehealth portal visits. Patients sent 1.34 billion messages to their healthcare providers and received some 3.25 billion online portal messages from providers.
"A big message from our paper is that we felt one hypothesis was that an increase in portal messaging, so patients interacting with clinicians via encrypted messages, would decrease the office visits, so in-person office visits, but seems it's not the case. It seems that this is a new modality that patients, but also healthcare systems and providers, have to embrace and prepare for," Mankowski said during a press briefing on Monday.
During the first three months of 2025, among active patients on Epic, which is about 42 million patients, 30% of these patients sent a portal health app message to their clinician, the study found.
“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,” Mankowski noted.
While digital health apps and portal messaging options have made it easier for patients to communicate with providers, these shifts have implications for staffing, workflow and reimbursement, researchers noted.
The digital delivery of healthcare is adding another layer of more steps to existing provider workflows, noted study co-investigator Dorry L. Segev, M.D., Ph.D. To manage this new patient reality, hospitals, clinics and healthcare workers have to plan future staffing and support, said Segev, a professor and vice chair in the Department of Surgery at NYU Grossman School of Medicine.
"Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload," said Segev, who is also a professor in NYU Grossman’s Department of Population Health. "Clinical staff will need to be trained in mastering the tools of messaging in healthcare; in using AI support programs, including chatbots that can frame content to minimize its complexity; and in making the most effective use of clinician time needed for online billing and online counseling."
NYU Langone uses AI support tools to speed up drafting of physician and provider notes, Segev noted.
Health systems and medical practices also contend with an emerging digital layer that runs parallel to the traditional healthcare system. Wearable devices, virtual care platforms and AI-powered healthcare chatbots offer an "always-on" alternative to episodic care.
"We do see this trend of healthcare becoming more continuous through your phone, and yes, it's a new shift. Healthcare has been episodic, from office visit to office visit, for many, many years, and that's exciting changes. There are opportunities, but also challenges," Mankowski said during the briefing.
"More data also means more burden for the healthcare system," he noted. "We can provide all this data, but this data have to be analyzed," which opens up the potential to use artificial intelligence tools to analyze patient-generated data and messages.
The researchers also looked at the patients who are sending the most portal messages. Based on first-quarter 2025 data, the majority of message senders, 86%, live in urban areas and 61% were women. A little more one-third (36%) were between the ages of 40 and 64, and 21% lived in the least socially vulnerable neighborhoods. Social vulnerability was based on the U.S. Centers for Disease Control and Prevention (CDC) social vulnerability index that factors in socioeconomic status, household characteristics, racial and ethnic minority status and housing type and transportation.
One in three patients in the least vulnerable neighborhoods used messaging versus roughly one in four in the most vulnerable, the study found. Lower use of portal messaging among patients living in socially vulnerable neighborhoods may widen existing access gaps, researchers noted.
"We do see disparities among more vulnerable populations and addressing those disparities is important for the healthcare system," Mankowski told reporters. "This is just a descriptive study without established causality, and we need to look more closely, but again, this seems to be the first evidence at the very national level."
Provider organizations will need to consider a team-based approach between clinicians, staff and leadership to decide the best way to reach their patients, Jane Long, M.D., lead investigator on the study and surgical resident in the department of surgery at NYU Grossman School of Medicine, told reporters during the press briefing.
"Messaging doesn't necessarily automatically mean that everyone is connected. There are people who are either not connected or messaging as frequently as others. Organizations need to take into account this increase in volume, but also to think about and be more thoughtful about who's not receiving care through these changes," Long said.
"There's a lot more granular data that we can delve into, so this was our first exploration," she added.
For the study, the team used Epic Cosmos, a national dataset of the electronic health records of more than 300 million American patients. The dataset includes information from a majority of hospitals and clinics that use Epic, which had no role in performing the study.
While there have been single-center studies looking at patient messages, the use of Epic's database for the JAMA study offers a look at the national landscape for patient communication, Mankowski said.
Future studies will delve deeper into message characteristics, response times and the impact on providers, he noted.
Segev said researchers next plan to look more specifically at digital-use trends within healthcare systems, including NYU Langone, to break down any regional and outpatient clinic-specific shifts that could affect operational planning.