Emojis are increasingly appearing in EHR, according to a new analysis of clinical notes that suggests informal digital symbols are making limited but growing inroads into healthcare communication.
Researchers reviewed 218.1 million clinical notes from 1.6 million patients and identified 372 unique emojis used across 4,162 notes between 2020 and 2025. Emoji use remains rare overall but exceeded levels reported in previous studies of clinical texting systems.
The findings were published in JAMA Network Open, according to a Jan. 14 press release from the University of Michigan.
Most emojis appeared in short messages sent from clinical teams to patients through patient portals, rather than in formal documentation, the release said. The majority of emoji-containing notes were sent by clinicians, not patients.
Smileys and emoticons accounted for 58.5% of emoji use, followed by objects at 21.2% and people- or body-related emojis at 17.6%. The smiling face with smiling eyes was the most commonly used emoji, appearing 1,772 times, followed by the telephone receiver and calendar emojis.
Emojis were rarely used as substitutes for words. About 1% replaced text, such as using a pill emoji in place of the word “medicine,” while most were used for emphasis or stylistic purposes, according to the release.
Researchers said the presence of emojis raises the potential for miscommunication, particularly among older patients. Records for patients ages 70 to 79 contained the second-highest number of emojis, behind those for patients ages 10 to 19.
Given the trend, researchers recommended that healthcare organizations consider developing guidelines for emoji use to maintain clarity and professionalism in clinical communications.
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