Emojis are everywhere in modern digital communication. They appear in text messaging, social media, and other forms of online conversation to express feelings, add nuance, or make messages more engaging. Recently published research shows that these small symbols are also making their way into clinical documentation and electronic health record (EHR) systems. A research letter published in JAMA Network Open examined how emojis are being used in EHR notes and what this might mean for patient care and communication. While the overall frequency of emojis in clinical notes remains low, the findings raise important questions about communication practices in healthcare settings.
This blog post breaks down the research findings, explains patterns of emoji use in healthcare records, explores potential risks and benefits, and discusses future directions for communication best practice in clinical documentation.
Researchers at the University of Michigan conducted a cross-sectional study to understand the frequency and context of emoji use in electronic health records. The study included 218.1 million clinical notes from 1.6 million patients created between January 2020 and September 2025 at Michigan Medicine. All emojis appearing in these notes were identified and analyzed.
The research team also selected 100 notes containing emojis from 2024 and 100 from 2025 to qualitatively code how emojis were used. They looked at factors such as who introduced the emoji, who the emoji was intended for, and how the emoji was being used in context. The study design followed the STROBE reporting guideline and was approved by the University of Michigan Institutional Review Board.
Although emojis were still rare overall, the study identified a notable number of distinct symbols. In total, 372 distinct emojis appeared in 4,162 clinical notes. From 2020 through 2024, usage remained relatively steady at about 1.4 notes with emojis per 100,000 overall notes. However, by the third quarter of 2025 this rate had increased to 10.7 notes per 100,000.
In other words, emoji use in clinical documentation is still uncommon compared to general digital communication, but growth is clear. It is also significantly higher than prior studies that focused on clinician-to-clinician texting systems, which found only about 42 unique emojis used in those secure messaging systems.
The types of clinical notes where emojis appeared were varied, with some clear patterns:
Interestingly, the patient portal used at Michigan Medicine did not allow patients to enter emojis directly. Therefore any patient-originated emoji appeared because it was copy-pasted from emails or text messages into the clinical note.
Among all emojis identified in notes, the distribution by category was as follows:
This distribution reflects everyday patterns of emoji use in digital messaging outside healthcare, with expressive facial emojis and simple objects showing up most often.
One key question was whether emojis were being added by patients or clinicians. When the research team qualitatively coded 200 clinical notes containing emojis from 2024 and 2025, they found that emojis were almost always added by clinicians or clinical staff (about 89 percent of notes). Only about 10.5 percent were clearly introduced by patients or family members through copy-pasted text.
The intended recipient of the emoji was most often a patient or family member, and in most cases the emoji appeared uniquely in the message (not as part of a standardized template). Emojis were used to express emotion or feeling in about 59.5 percent of notes and informational or symbolic use accounted for the rest.
Most messages containing emojis used them either as stand-alone elements (57 percent of notes) or to augment text (42 percent). Very rarely was an emoji used to replace a word in a phrase (about 1 percent of cases). Examples of functional use might include using a carrot emoji to encourage eating more vegetables.
The study also examined how emoji use in patient portal messages varied by patient age group. The highest rate was among adolescents and younger adults. Patients aged 10 to 19 years had the highest use rate. Surprisingly, the next highest rate was among older adults aged 70 to 79 years. Use then declined among older age groups.
This pattern is significant because emoji interpretation can vary by age and cultural context. Older adults may have differing familiarity with emoji symbols, which could lead to misinterpretation or unintended confusion. Other research supports the idea that emoji comprehension varies by age, gender, and cultural factors.
The presence of emojis in clinical documentation presents both opportunities and challenges.
The authors of the JAMA Network Open study suggest that healthcare institutions should consider monitoring emoji use in clinical communication and develop guidelines to manage their use. Establishing clear policies may help maximize the benefits of using visual symbols while minimizing potential risks.
Future research is needed to understand whether emoji use affects patient outcomes, patient understanding, or satisfaction with clinical communications. It may also be useful to explore linking emojis to specific clinical concepts or designing training for clinicians on effective communication practices.
This research adds to a growing body of work exploring how emojis function in different types of communication. Previous studies have looked at emoji use in clinician texting systems and found that emojis often convey emotion or help with interaction flow. Other work has highlighted the limitations of emojis when representing medical terminology, suggesting a need for better visual language tools in healthcare.
As communication channels continue to evolve and digital messaging becomes more central in patient care, understanding how people interpret visual elements like emojis will only become more important.
Emoji use in electronic health records is still uncommon but increasing. The latest research from Michigan Medicine shows that clinicians are adding emojis to clinical notes in a small proportion of cases, particularly in patient-facing messages. While emojis can add personality and warmth to communication, they also raise concerns about clarity, interpretation, and professionalism.
Healthcare organizations should track emoji use, consider policy development, and invest in research to understand how emojis influence patient comprehension and clinical outcomes. Clear communication is essential in healthcare, and small visual symbols may have a larger impact than expected.
This blog post summarizes a research study published in JAMA Network Open and related coverage by news outlets and academic summaries. It is intended for educational and informational purposes only. The content should not be taken as medical advice or guidance. Readers should consult qualified health professionals for decisions about clinical practice and patient communication policies.
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