Portal messaging proves ‘an expansion of between-visit care rather than a substitute for in-person care’

Any lingering fears about patients using online portals to get bonus medical attention for free should be largely quieted, albeit not completely silenced, by a new study conducted at New York University. 

Analyzing aggregated and deidentified EHR data from more than 2,000 hospitals and 47,000 clinics, the researchers found usage of patient portals indeed exploded between 2020 and 2025. 

However, they also found significant proliferations in office visits as well as the overall population of active patients. 

The work is fleshed out in a study published June 22 in the Journal of the American Medical Association. The report is lead-authored by Jane Long, MD, and senior-authored by Michal Mankowski, PhD.  

The team’s key finding: Patient-authored portal messages increased from 0.99 to 2.50 per patient per year—a hefty 153% rise—while telephone encounters declined from 2.33 to 2.20 (−6%) and office visits increased from 2.37 to 2.77 per patient per year (17%). 

A ‘structural shift in communication’ 

No less telling: 

• The number of active patients increased from 94.3 million in early 2020 to 140.5 million late 2025. 
   
• The study period saw 1.77 billion office visits, 1.34 billion patient-authored and 3.25 billion clinician- and staff-authored messages, 1.59 billion telephone encounters and 146 million telehealth encounters. 

For the study authors, the findings suggest that portal messaging “functions as an expansion of between-visit care rather than a substitute for in-person care.”

They also note that the COVID-19 pandemic marked an early peak in telephone encounters and clinician- and staff-authored portal messages, which has only partially normalized since that time. 

Meanwhile patient-authored messaging increased gradually, “indicating a structural shift in communication rather than a transient disruption.”

Results that demand a plan 

The researchers further found the count of portal messages authored by clinicians and staff grew from 4.59 to 5.70 per patient per year (24%), notching a “transient” COVID-19 pandemic peak of 6.86 per patient per year in 2021.

Messaging intensity—meaning mainly volume and frequency—more than doubled, spiking from 2.2 to 5.4 messages per message sender per year.

Finally, telehealth visits spiked during the COVID-19 pandemic; however, by 2025, they accounted for only 0.19 visits per active patient per year.

In their discussion, the authors note the “inequitable distribution” of portal usage even as portal messaging “becomes a core communication modality.”

“This shift has practical implications for staffing, workflow and reimbursement, as more patient care now occurs asynchronously, often outside traditional visits,” Long et al. remark. “Health systems may need to plan not only for increased messaging volume but also for addressing engagement gaps among underserved populations.” 

Welcome to the new normal 

In coverage of the study by NYU’s news operation, Mankowski underscores that patient portal messages are not replacing in-office visits. 

He points to the doubling of messages from patients to healthcare providers since the pandemic. 

“Our study shows that use of patient portals, health apps and messaging are now a routine part of everyday patient care across America,” Mankowski says, “not simply side channels used occasionally.”

Co-investigator Dorry Segev, MD, PhD, adds that “modern delivery of healthcare” increasingly requires smart workload management.

“Healthcare providers [now] have to balance their digital workload on top of their traditional clinical workload,” Segev says. “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.” 

The NYU news item is here, and the study is posted in full for free.