Patient messages to clinicians surge 153%: JAMA
WASHINGTON, UNITED STATES — Patients are not just messaging their doctors more — they are doing it at a rate that has fundamentally changed the administrative load of clinical care.
A JAMA study found that patient-authored messages in the Epic electronic health record (EHR) system surged 153% between 2020 and 2025, growing from 0.99 to 2.5 messages per patient annually.
Patient portal messages outpace telephone encounters
The study analyzed more than 140 million patient records from 2,067 hospitals and 47,100 clinics, capturing over 8 billion patient-provider interactions in Epic’s Cosmos database.
In that span, total patient-authored messages reached 1.34 billion — while active portal users grew from 94.3 million to 140.5 million.
The shift is structural, not cyclical. While telephone visits declined approximately 6% over the same period, in-person office visits grew 17% — indicating that patient portal messaging is supplementing, not replacing, traditional care encounters.
“The operational implications are immediate: health systems must account for message volume in staffing models, explicitly allocate time for inbox management within clinician schedules, and redesign workflows to integrate asynchronous care alongside visits,” wrote Melanie Molina, M.D., a physician at UCSF, and Joseph S. Ross, M.D., JAMA Deputy Editor, in an accompanying editorial.
Women ages 40–64 in lower-vulnerability neighborhoods drove the highest message volumes — revealing both the digital engagement opportunity and the equity gap among underserved populations that are less likely to use portal messaging.
Clinician inbox load demands new workflows
The messaging surge is landing directly in clinician inboxes. Clinician response messages more than doubled — from 2.2 to 5.4 per sender annually — with the NYU Langone Health research team noting a compounding administrative burden across specialties.
“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,” said Dorry L. Segev, M.D., professor and co-investigator at NYU Grossman School of Medicine.
As message volumes compound year over year, the unsupported inbox becomes a direct contributor to physician burnout — making workflow redesign and AI-assisted triage not optional enhancements, but operational necessities.
For healthcare outsourcing providers, the messaging surge is a concrete staffing signal. Health systems absorbing 153% more patient communication require scalable inbox management, message triage, and response support infrastructure — functions that offshore clinical and administrative teams are increasingly positioned to deliver.
Digital access is no longer a feature. It is a care channel under pressure.
