Digital health tools are reshaping health care in the United States
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At least 12% of Americans now communicate with their health care providers about appointments, test results and ongoing treatments via secure online patient portals and health apps, a new study shows. Meanwhile, traditional in-person visits to the doctor's office have rebounded since the pandemic. Although digital medicine has become a routine part of health care, it is supplementing rather than replacing in-person care. This evolution, researchers say, is reshaping how hospitals and clinics operate daily.
These are the main conclusions of the study, which was led by researchers at NYU Langone Health and 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 more than 8 billion patient-provider interactions that took place between January 2020 and December 2025.
Published in the Journal of the American Medical Association (JAMA), the study team found that online portal messages more than doubled between 2020 and 2025 (by 153%). By contrast, total telephone calls decreased by 6% over the same period. The number of Americans with an active Epic health record went from 94 million in 2020 to 140 million in 2025. Thirty percent of active patients on Epic (42 million) sent a portal health app message to their clinician during the first three months of 2025.
Patient portal visits, however, are not replacing in-office visits, which have returned to an average of between two and three per year per patient. Messages from patients to health care providers have doubled since the pandemic, from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025.
"Our study shows that use of patient portals, health apps, and messaging is 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.
Mankowski, an assistant professor in the Department of Surgery at NYU Grossman School of Medicine, said the study demonstrates that patients now have much more direct access to physicians and other clinicians.
"Our findings reveal that while digital health tools have become a core part of health care, delivery is becoming more continuous, timeless, and no longer tied to scheduled appointments during routine work hours," said Mankowski.
Among the study's other findings was that since 2020, Americans have—as logged in Epic record systems—booked at least 1.77 billion in-person visits to health clinics, sent 1.34 billion messages to their health care providers and received some 3.25 billion online portal messages from providers. Also documented in Epic were 1.59 billion telephone calls and 146 million virtual telehealth portal visits.
Study co-investigator Dorry L. Segev, MD, Ph.D., said that the digital delivery of health care does not replace the old ways of working; it just adds another layer of more steps to existing workflows. To manage this new patient reality, hospitals, clinics and health care workers have to plan future staffing and support.
"Modern delivery of health care means increasingly that health care providers will have to balance their digital workload on top of their traditional clinical workload," said 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 health care; 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 Segev, who is also a professor in NYU Grossman's Department of Population Health.
Already, he noted, NYU Langone uses AI support tools to speed up drafting of physician and provider notes.
Segev said the team next plans to look more specifically at digital-use trends within health care systems, including NYU Langone, to break down any regional and outpatient clinic-specific shifts that could affect operational planning.
For the study, the team used Epic Cosmos, a national data set of the electronic health records of more than 300 million American patients. The data set includes information from a majority of hospitals and clinics that use Epic, the nation's largest vendor of electronic health record systems, which had no role in performing the study.
Publication details
Trends in Patient Portal Messages, Office Visits, and Telephone Encounters, JAMA (2026). DOI: 10.1001/jama.2026.8690
Journal information: Journal of the American Medical Association
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