What increased portal message volume, in-person visit volume say about the future of care

The volume of patient portal messages has more than doubled since the pre-pandemic days of early 2020, according to research from NYU Langone. Telephone calls are down over the same time, but in-person visits are up. That leads researchers to believe care delivery patterns have permanently shifted – and may require a shift in hospital staffing and support models.

The Journal of the American Medical Association paper evaluated 8 billion patient-provider interactions through 140 million patient records within the Epic electronic health record (EHR) system that occurred between January 2020 and December 2025. Over that time:

Portal messages increased 153%, with the number of messages sent per patient annually increased from 2.2 in early 2020 to 5.4 by late 2025

Patients in the study sent 1.34 billion message to providers and received 3.25 billion messages from providers

In-person visit volume increased 17%, with patients in the study booking 1.77 billion visits compared to 146 million telehealth visits

Phone call volume decreased 6%, with 1.59 billion calls documented in Epic

In a statement, study authors said the findings indicate that portal messaging – and, more broadly, the use of digital health applications – is “now a routine part of everyday patient care” and not a “side channel” used infrequently.

“Our findings reveal that while digital health tools have become a core part of healthcare, delivery is becoming more continuous, timeless, and no longer tied to scheduled appointments during routine work hours,” said Michal A. Mankowski, PhD, assistant professor at NYU Grossman School of Medicine’s Department of Surgery.

Balancing clinical and digital workflows

That’s all well and good, but it’s hitting health systems at a tough time. In 2024, burnout rates hovered around 50% for physicians and 70% for nurses, and completing administrative tasks and documenting care in the EHR are common sources of frustration for both groups. Managing portal messages only adds to that burden and further eats into the time clinicians can spend on direct patient care.

This points to the broader reality of contemporary healthcare, according to Dorry L. Segev, MD, PhD, professor and vice chair at NYU Grossman’s Department of Surgery. Digital care delivery is another layer atop existing clinical workflows, not necessarily a replacement for in-person care. (Otherwise, visit volume arguably wouldn’t have grown as much.)

Put another way: Providers must find a way to balance clinical and digital workflows. In a statement, Segev said this means training clinical staff in messaging applications, chatbots, and other AI support tools.

Broadly rethinking how care gets delivered

This work is underway at NYU Langone and elsewhere – and so far, it seems to be having a positive effect. Burnout rates have fallen in recent years, thanks in part to technology such as ambient AI documentation and natural language processing (NLP) filters on inbound portal messages, which can help clinicians better manage patient communication.

That said, broader systemic changes may be necessary to support the increased presence of digital tools in clinical care. Segev said health systems should explore how to use clinicians’ time most effectively. This matters for patient outcomes as well as billing purposes, as time spent answering portal messages or conducting virtual visits doesn’t drive revenue growth.

Broader change can present opportunities to make virtual care more financially viable, especially in outpatient settings where follow-up visits for condition management don’t require an in-person appointment. In many ways, it’s a natural step for health systems already rethinking care delivery workflows amid surging patient interest in digital communication.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.