11 ways to dig out of the patient portal inbox

Patient portal messages climbed 153 percent between 2020 and 2025, according to a JAMA study of Epic data covering roughly 8 billion encounters. Telephone calls fell 6 percent over the same stretch. Office visits rose 17 percent. The message volume did not move work out of the phones or the schedule. It stacked on top.

The per-patient math is the part that lands in the exam room. The average patient sent 2.2 messages a year in early 2020 and 5.4 by late 2025, and 30 percent of active Epic patients, about 42 million people, sent at least one message in the first quarter of 2025 alone. An accompanying JAMA editorial put it plainly, arguing that the clinician inbox is now central to practice rather than peripheral to it, and that failing to give physicians time to respond pushes uncompensated after-hours work onto them.

Most practices are still running the inbox the way they ran it when it was a novelty: everything flows to the physician, response time is whatever it is and nobody bills for any of it. Here are 11 changes that pull the inbox back under control.