Portal Messaging Rose 153% Without Cutting Oncology Visits

Key Takeaways

• Across 2,067 hospitals and 47,100 clinics nationwide, patient-authored portal messaging rose 153% from 2020 to 2025 while office visits also increased 17%.
• Among patients who sent at least one portal message, messaging intensity increased 146% over the study period.
• The active-patient population grew by about 50%, and the analysis captured billions of messages, office visits, and telephone interactions, plus 146 million telehealth encounters across the study period.
• Prior oncology context, separate from the national JAMA dataset, showed patient-initiated messages to oncologists increased 34% from 2019 to 2022.

Whether easier digital communication reduces in-person care has become a central care-delivery question as patient portals absorb more of the routine back-and-forth between patients and clinical teams. In a national analysis, investigators compared trends in messaging with office visits, telehealth, and telephone encounters to assess whether portal use was displacing other care contacts. The analysis provided a national view of how those channels changed over time.

In a JAMA analysis of portal messaging and office-visit trends, the authors conducted a cross-sectional analysis of electronic health record (EHR) data from 2,067 hospitals and 47,100 clinics. The primary endpoint was national trends in patient portal messaging, office visits, telehealth, and telephone encounters. The analysis spanned Q1 2020 through Q4 2025, during which the number of active patients increased from 94.3 million to 140.5 million. This design provided a national view of how communication volumes changed as the care network expanded.

Across the study period, the researchers identified 1.34 billion patient-authored messages, 3.25 billion clinician/staff-authored messages, 1.77 billion office visits, 1.59 billion telephone interactions, and 146 million telehealth encounters. Annual patient-authored portal messaging increased from 0.99 per patient in 2020 to 2.5 per patient in 2025. Over the same interval, office visits increased from 2.37 to 2.77 per patient, whereas telephone encounters declined from 2.33 to 2.2 per patient. The overall pattern showed expanding digital communication alongside continued growth in office-based care.

Among patients who sent at least one message, intensity increased from 2.2 to 5.4 messages per sender per year. Clinician/staff-authored messages also rose from 4.59 to 5.7 per patient, with a peak of 6.86 per patient in 2021 during the COVID-19 pandemic. In Q1 2025, 41.8 million of 139.4 million active patients were message senders, and telehealth measured 0.19 visits per patient annually in 2025. Messaging varied by age and rurality (P < .001). Sender prevalence was higher among women than men at 33% vs 26.1% and among patients in the lowest vs highest social vulnerability index (SVI) quartile at 36.7% vs 25.2%, with P < .001 for both comparisons. These findings suggest that the shift in communication volume was not uniform across patient groups or care modalities.

The authors described these data as cross-sectional utilization trends, meaning the analysis does not establish that more portal messaging caused changes in office visits, telephone use, or telehealth. They also noted that changes in the patient network over time could have influenced observed trends. The investigators interpreted portal messages as an added communication channel that often required chart review, medication review, and coordination across the care team. Separate prior oncology context came from patient-initiated messages to oncologists, which increased 34% between 2019 and 2022.

By the end of the study period, messaging continued to rise without a parallel drop in office-based care. According to the investigators, they had not observed a plateau and the overall pattern reflected additive use of portal communication rather than substitution for in-person visits.

Clinician Questions

How much did patient portal messaging increase nationally between 2020 and 2025?

In the national cross-sectional EHR analysis spanning 2,067 hospitals and 47,100 clinics, annual patient-authored portal messages increased from 0.99 to 2.5 per patient between 2020 and 2025, and among patients who sent at least one message, intensity increased from 2.2 to 5.4 messages per sender per year.

Did office visits decline as portal messaging increased?

Office visits did not decline during the same period; they increased from 2.37 to 2.77 per patient, while telephone encounters declined from 2.33 to 2.2 per patient and telehealth measured 0.19 visits per patient annually in 2025. The investigators interpreted that pattern as messaging being additive rather than substitutive.

Who was most likely to send portal messages in early 2025?

In Q1 2025, 41.8 million of 139.4 million active patients were message senders. Messaging varied by age and rurality, women were more likely than men to be senders at 33% vs 26.1%, and patients in the lowest vs highest social vulnerability index quartile were more likely to be senders at 36.7% vs 25.2%, with significant differences reported.

What oncology-specific portal messaging trend was cited alongside the national analysis?

Prior Journal of the National Cancer Institute data cited alongside the national analysis showed that patient-initiated messages to oncologists increased 34% between 2019 and 2022, and that finding was presented as contextual prior evidence rather than as part of the JAMA trend dataset.