Digital communication has become a central part of modern healthcare, and new research published in JAMA highlights just how significant that shift has become. A nationwide study examining patient portal messages, office visits, telephone encounters, and telehealth usage found a dramatic increase in patient-clinician messaging between 2020 and 2025.
As healthcare organizations continue investing in digital tools, patient portals are increasingly serving as a key channel for communication between patients and care teams. The findings suggest that online messaging is not replacing traditional healthcare visits. Instead, it is expanding the ways patients interact with clinicians and access care.
Researchers analyzed deidentified electronic health record data from Epic Cosmos, one of the largest healthcare databases in the United States. The dataset included information from more than 2,000 hospitals and over 47,000 clinics nationwide.
The study evaluated communication patterns among active patients, focusing on:
The researchers also explored differences in portal usage based on age, gender, social vulnerability, and geographic location.
One of the most striking findings was the rapid growth in patient-generated portal messages.
Between the first quarter of 2020 and the fourth quarter of 2025:
The increase reflects growing comfort among patients with digital communication tools and greater reliance on portals for managing healthcare needs.
Portal messages often include:
As patients become more accustomed to accessing healthcare online, messaging has evolved into a routine component of care delivery.
Contrary to concerns that digital communication could reduce in-person care, the study found that office visits actually increased over time.
Researchers reported:
The findings indicate that patient portal messaging is not replacing face-to-face appointments. Instead, it appears to complement traditional healthcare services.
Patients may use portal messages to address questions between appointments while still attending necessary office visits for diagnosis, treatment, and ongoing management.
While patient messaging increased significantly, telephone communication showed only a modest decline.
Telephone encounters:
The relatively small decrease suggests that messaging has not fully displaced phone-based communication. Many patients and healthcare organizations continue to rely on telephone conversations for urgent concerns, complex discussions, and care coordination.
Researchers noted that increases in messaging were positively associated with telephone encounters rather than replacing them entirely. This finding supports the idea that digital communication expands overall patient engagement rather than substituting for existing communication channels.
The COVID-19 pandemic dramatically accelerated telehealth adoption across the healthcare industry. However, the study found that telehealth usage eventually stabilized at much lower levels than many anticipated.
Although telehealth visits spiked during the pandemic years, by 2025 they accounted for only 0.19 visits per active patient annually.
This suggests that while telehealth remains an important care option, patient portal messaging has become a more consistently utilized digital communication tool.
Unlike scheduled telehealth appointments, portal messaging allows patients and clinicians to communicate asynchronously, making it a convenient option for many routine healthcare needs.
The study identified several demographic patterns associated with higher portal messaging use.
Adults between 40 and 64 years of age were the most active users, with a messaging prevalence rate of 35.1%.
Usage rates included:
Middle-aged and older adults appear particularly engaged with digital healthcare communication.
Women were more likely to use patient portal messaging than men.
Messaging prevalence was:
This difference may reflect broader trends in healthcare utilization, as women often engage more actively in healthcare management for themselves and family members.
Researchers found significant disparities based on neighborhood social vulnerability.
Patients living in areas with lower social vulnerability had higher messaging participation rates than those living in more vulnerable communities.
This finding raises concerns about digital health equity and highlights the need for strategies that ensure all populations can benefit from expanding digital healthcare services.
Portal messaging was slightly more common among patients living in metropolitan and urban areas compared with those in micropolitan, small-town, or rural settings.
Differences in internet access, digital literacy, and healthcare infrastructure may contribute to these variations.
The study's results have important implications for healthcare leaders, clinicians, and policymakers.
As messaging volume continues to rise, healthcare organizations must address several operational challenges:
Many portal interactions occur outside traditional appointment structures. As a result, clinicians often spend substantial time responding to messages without corresponding adjustments to workflow or compensation models.
Without adequate support, increasing message volumes may contribute to clinician burnout and administrative burden.
Researchers concluded that patient portal messaging is becoming a fundamental component of healthcare delivery rather than a temporary trend.
The growth appears to represent a long-term transformation in patient-clinician communication. Future research will likely examine:
As healthcare continues evolving toward more connected and patient-centered models, digital messaging will likely play an even greater role in care coordination and patient engagement.
Healthcare systems that proactively adapt staffing models, technology platforms, and access strategies may be better positioned to meet growing patient expectations while maintaining high-quality care.
Long JJ, McAdams-DeMarco MA, Schwartz MD, et al. Trends in Patient Portal Messages, Office Visits, and Telephone Encounters. JAMA. Published online June 22, 2026. doi:10.1001/jama.2026.8690.
This article is intended for informational and educational purposes only. It summarizes findings from a published research study and should not be considered medical, legal, or professional advice. Healthcare decisions should always be made in consultation with qualified healthcare professionals. The interpretations presented here are based on the referenced publication and do not replace individualized medical guidance.
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