To examine the frequency and context of emoji usage in electronic health record (EHR) notes and its implications for enhancing clinician-patient communication.
Key Findings:
Emoji usage in EHRs was uncommon but increased over time, from 1.4 notes per 100,000 in 2020-2024 to 10.7 by Q3 2025.
24% of emoji-containing notes included multiple emojis, with a median of four emojis per note.
Most emojis were found in patient-facing communications, particularly portal messages (36%) and telephone encounters (29%).
Patients could not enter emojis through the Epic portal, and no emojis were found in over 34 million patient-written messages.
The most common emojis included smiley faces, telephone receivers, and calendars, primarily used for emotional tone and visual cues.
Interpretation:
Emojis may enhance clinician-patient communication by conveying warmth and approachability, though their interpretation can vary based on patient demographics and context.
Limitations:
The study did not assess patient outcomes or the effectiveness of emojis in improving understanding.
Potential for misinterpretation of emojis based on age, cultural background, and digital communication familiarity, which could affect communication efficacy.
Conclusion:
As patient messaging becomes more integral to clinical work, health systems should consider guidelines for emoji use to ensure clear and effective communication.
Longitudinal cohort data linked bullying and persistently unsupportive state gender-identity policies with worsening psychotic-like experiences among gender-diverse youths.
