American researchers executed a cross-sectional examination of emoji usage within electronic health records and patient correspondence at a major academic medical facility. They found that their deployment has lately surged, with the highest rates occurring when communicating with adolescents and seniors, which might possibly lead to difficulties in message understanding. An article detailing this is featured in the journal JAMA Network Open.
Beyond broad application in personal exchanges and online platforms, emojis are infiltrating diverse professional spheres—specifically, it has been demonstrated that clinicians frequently employ them when liaising with peers. Whether this impacts documentation and patient communication remains unexplored, as do the possible ramifications of this trend.
David Hanauer of the University of Michigan, along with collaborators, compiled and analyzed a dataset comprising 218.1 million entries (including messages, patient instructions, and logs from in-person and telemedicine appointments) from the electronic health records of 1.6 million patients at the university medical center between January 2020 and September 2025. All utilized emojis were identified and categorized by date, record type, and patient age.
Overall, the dataset contained 4,162 records featuring 372 distinct emojis. 1,011 of these entries included multiple emojis (a median of four, with a maximum of 32). Their use held steady at roughly 1.4 records with emojis per 100,000 records from 2020 through 2024, then sharply rose to 10.7 per 100,000 records by Q3 2025. By Unicode categories, smileys and emotions were most prevalent (58.5 percent of emoji entries), followed by objects (21.2 percent), people and body parts (17.6 percent), symbols (11.9 percent), animals and nature (10.6 percent), travel (8.9 percent), food and drink (3.4 percent), and others (under one percent each).
The 50 most frequently used emojis in medical charts
The 50 most frequently used emojis in medical charts
David Hanauer et al. / JAMA Network Open, 2026
Emojis appeared most often in messages sent to patients via the clinic portal (35.5 percent), followed by telemedicine consultations (28.5 percent), appointment logs (15.3 percent), condition progress notes (13.9 percent), patient directives (6.4 percent), and miscellaneous (0.5 percent). Patients lacked the capability to insert emojis into their portal messages. The incidence of emoji use per 100,000 messages was highest in records for patients aged 10 to 19 and 70 to 79.
Although emoji usage in electronic health record entries was generally infrequent, the steep increase in frequency without discernible causes (such as adding them to messaging features) and the age-based distribution are noteworthy. Given that emoji interpretation can differ based on age and cultural background, and existing data on their use by seniors is conflicting (pro and con), such patterns raise concerns as they might affect the perception and comprehension of sensitive medical information.
The study has several limitations, stemming from its single-site design and the absence of data on how healthcare providers and patients interpret emojis and how this relates to clinical outcomes. Consequently, the authors urge other research and healthcare organizations to conduct their own investigations in this area and, if necessary, develop guidelines for emoji utilization in clinical documentation and patient communication.
Prior research has indicated that emojis in personal correspondence help one appear more responsive and contribute to dating success, whereas in business settings, they signal a lack of competence. Nature-themed emojis poorly reflect biodiversity, while smileys and genuine human faces elicit comparable brain responses.
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