U.S. — Researchers at NYU Langone Health published a study in the Journal of the American Medical Association online on June 22, 2026, finding that online portal messaging has become a core component of routine healthcare in the U.S. The study analyzed over 8 billion patient-provider interactions recorded between January 2020 and December 2025.

The analysis involved more than 140 million patient records from 2,067 hospitals and 47,100 health clinics. Online portal messages increased by 153 percent between 2020 and 2025. Messages from patients to healthcare providers rose from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025. At least 12 percent of Americans communicate with healthcare providers about appointments, test results, and ongoing treatments via secure online patient portals and health apps.

Total telephone calls decreased by 6 percent during the same period. Since 2020, Americans sent 1.34 billion messages to their healthcare providers and received 3.25 billion online portal messages from providers. Epic records also documented 1.59 billion telephone calls and 146 million virtual telehealth portal visits since 2020. Americans booked 1.77 billion in-person visits to health clinics as logged in Epic record systems.

"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, a study senior investigator and assistant professor in the Department of Surgery at NYU Grossman School of Medicine. "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 number of Americans with an active Epic health record increased from 94 million in 2020 to 140 million in 2025. Thirty percent of active patients on Epic, totaling 42 million people, sent a portal health app message to their clinician during the first three months of 2025.

"Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload," said Dorry L. Segev, a professor and vice chair in the Department of Surgery at NYU Grossman School of Medicine. "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."

The study used Epic Cosmos, a national dataset of electronic health records. NYU Langone uses AI support tools to speed up drafting of physician and provider notes. Funding for the study was provided by NYU Langone.