Digital Health Tools Are Now a Routine Part of Everyday Care in the US
Key Takeaways:
- A landmark review of more than 8 billion interactions across US healthcare finds that online portal messaging has become a standard, everyday part of care rather than an occasional add-on.
- Digital communication is supplementing in-person medicine, not replacing it – office visits have rebounded to two to three per patient each year while portal messages have more than doubled.
- Researchers warn that the growing digital workload sits on top of clinicians’ existing duties, raising new questions about staffing, training and the role of AI support tools.
A new picture of how Americans reach their clinicians
At least 12 per cent of people in the United States now contact their healthcare providers about appointments, test results and ongoing treatments through secure online patient portals and health apps, according to a major new study. At the same time, traditional in-person visits to the doctor’s office have recovered from their pandemic-era decline. The findings suggest that while digital medicine has become a routine feature of care, it is adding to in-person services rather than displacing them – an evolution that researchers say is reshaping how hospitals and clinics run day to day.
These are the central conclusions of a study led by researchers at NYU Langone Health, described as the largest review ever conducted of communications recorded in Epic electronic health records. The team analysed more than 140 million patient records drawn from 2,067 hospitals and 47,100 health clinics across the US, examining over 8 billion interactions between patients and providers that took place between January 2020 and December 2025.
What the data showed
Published online in the Journal of the American Medical Association (JAMA) on 22 June, the study found that online portal messages more than doubled between 2020 and 2025, rising by 153 per cent. Over the same period, total telephone calls fell by 6 per cent. The number of people with an active Epic health record climbed from 94 million in 2020 to 140 million in 2025. During the first three months of 2025, 30 per cent of active Epic patients – some 42 million people – sent a portal or health app message to their clinician.
Crucially, this surge in portal activity is not coming at the expense of face-to-face care. In-office visits have returned to an average of between two and three per patient each year. Messages from patients to their providers have, meanwhile, doubled since the pandemic, increasing from an average 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 are now a routine part of everyday patient care across America, not simply side channels used occasionally,” said study senior investigator Michal A. Mankowski, PhD.
Dr Mankowski, an assistant professor in the Department of Surgery at NYU Grossman School of Medicine, said the findings show that people now have far more direct access to physicians and other clinicians than before.
“Our findings reveal that while digital health tools have become a core part of healthcare, delivery is becoming more continuous and timeless, and no longer tied to scheduled appointments during routine work hours,” said Dr Mankowski.
The scale of digital care since 2020
The review also quantified the sheer volume of activity logged through Epic record systems since 2020. Over that period, people in the US booked at least 1.77 billion in-person visits to health clinics, sent 1.34 billion messages to their providers and received roughly 3.25 billion portal messages from providers in return. Epic systems also documented 1.59 billion telephone calls and 146 million virtual telehealth portal visits.
A new layer on top of clinical work
Study co-investigator Dorry L. Segev, MD, PhD, said the digital delivery of healthcare does not replace established ways of working; rather, it adds a further layer of steps to existing workflows. To cope with this new reality, he argued, hospitals, clinics and healthcare workers will need to plan ahead for staffing and support.
“Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload,” said Dr 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,” added Dr Segev, who is also a professor in NYU Grossman’s Department of Population Health.
He noted that NYU Langone already uses AI support tools to speed up the drafting of physician and provider notes. Looking ahead, Dr Segev said the team plans to examine digital-use trends within individual healthcare systems, including NYU Langone, in order to identify regional and outpatient clinic-specific shifts that could affect operational planning.
How the study was carried out
For the research, the team drew on Epic Cosmos, a national dataset containing the electronic health records of more than 300 million patients in the US. The dataset includes information from a majority of the hospitals and clinics that use Epic, the country’s largest vendor of electronic health record systems. Epic had no role in carrying out the study. Funding was provided by NYU Langone.
Alongside Dr Mankowski and Dr Segev, the NYU Langone researchers involved were lead investigator Jane J. Long, MD, and co-investigators Mara A. McAdams DeMarco, PhD; Mark D. Schwartz, MD; Joshua Chodosh, MD; and Eric K. Oermann, MD.
Disclosures
Dr Mankowski was recently elected to serve on the governing board of Epic Cosmos. Dr Schwartz reported being president-elect of the Society of General Internal Medicine. Dr Segev has received consulting and/or speaking honoraria from Sanofi, CareDx, Moderna, AstraZeneca, Roche, Optum, OrganOx, Hansa and Biosidus, and is a journal editor for Springer. None of these activities are related to the current JAMA study. NYU Langone is managing the terms and conditions of these relationships in accordance with its policies and procedures.
Source: NYU Langone
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