Jun 26, 2026 · 9 min · 8 segments
Editor's Summary by Linda Brubaker, MD and Christopher C. Muth, MD, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from…
Christopher MuthHostLinda BrubakerHostChris, I'd like to start with the communication transformation that has really exploded in recent years, patient portal messages.
In this cross-sectional analysis of approximately eight billion encounters between twenty twenty to twenty twenty-five, Dr.
Long and colleagues analyzed Epic Cosmos data from across more than two thousand hospitals and forty-seven thousand clinics.
Both patient and clinician-authored portal messages increased, with patient messages per person increasing from around one per patient per year to two point five per patient per year, or about a hundred and fifty-three percent increase.
It came on top, resulting in a larger total communication workload and suggesting that as messaging becomes a core communication channel, health systems need to adapt to this rising volume and any potential disparities in access.
The Cosmos data resource is really spectacular, but is there any reason you would think that the findings would be different if you were looking at data from a different EHR vendor or anything like that?
Epic has, like, a pretty large penetration right now in the market, I think especially nowadays.
But of course, other vendors might have a bit different workflows, how basically their messages are handled.
But I still believe that overall, if a person wants to send a message, they can send a message, and this message will be responded.
So while, of course, we are kind of looking at the one vendor only, yes, I think we can be pretty certain those trends more or less generalize.
And in an accompanying editorial, Doctors Molina and Ross discuss how this shift to asynchronous electronic messaging has reached a tipping point.
Health systems must update staffing models and workflows to match this reality.
Otherwise, more care shifts outside the visit, often into uncompensated clinician time, increasing the risk of burnout and missed patient needs.
Chris, I'd like to start with the communication transformation that has really exploded in recent years, patient portal messages.
In this cross-sectional analysis of approximately eight billion encounters between twenty twenty to twenty twenty-five, Dr.
Long and colleagues analyzed Epic Cosmos data from across more than two thousand hospitals and forty-seven thousand clinics.
Both patient and clinician-authored portal messages increased, with patient messages per person increasing from around one per patient per year to two point five per patient per year, or about a hundred and fifty-three percent increase.
It came on top, resulting in a larger total communication workload and suggesting that as messaging becomes a core communication channel, health systems need to adapt to this rising volume and any potential disparities in access.
The Cosmos data resource is really spectacular, but is there any reason you would think that the findings would be different if you were looking at data from a different EHR vendor or anything like that?
Epic has, like, a pretty large penetration right now in the market, I think especially nowadays.
But of course, other vendors might have a bit different workflows, how basically their messages are handled.
But I still believe that overall, if a person wants to send a message, they can send a message, and this message will be responded.
So while, of course, we are kind of looking at the one vendor only, yes, I think we can be pretty certain those trends more or less generalize.
And in an accompanying editorial, Doctors Molina and Ross discuss how this shift to asynchronous electronic messaging has reached a tipping point.
Health systems must update staffing models and workflows to match this reality.
Otherwise, more care shifts outside the visit, often into uncompensated clinician time, increasing the risk of burnout and missed patient needs.
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