Digital health tools are reshaping healthcare in the United States

NYU Langone Health / NYU Grossman School of Medicine

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At least 12 percent of Americans now communicate with their healthcare providers about appointments, test results, and ongoing treatments via secure online patient portals and health apps, a new study shows.

Meanwhile, traditional, in-person visits to the doctor’s office have rebounded since the pandemic. And although digital medicine has become a routine part of healthcare, it is supplementing rather than replacing in-person care. This evolution, researchers say, is reshaping how hospitals and clinics operate daily.

These are the main conclusions of the study, which was led by researchers at NYU Langone Health and represents the largest review ever performed on communications recorded by Epic electronic health records. The team’s analysis involved more than 140 million patient records from 2,067 hospitals and 47,100 health clinics in the US. As part of the study, the researchers evaluated over 8 billion patient-provider interactions that took place between January 2020 and December 2025.

Publishing in the Journal of the American Medical Association (JAMA) online June 22, the study team found that online portal messages more than doubled between 2020 and 2025 (by 153 percent). By contrast, total telephone calls decreased by 6 percent over the same period. The number of Americans with an active Epic health record went from 94 million in 2020 to 140 million in 2025. Thirty percent of active patients on Epic (42 million) sent a portal health app message to their clinician during the first three months of 2025.

Patient portal visits, however, are not replacing in-office visits, which have returned to an average of between two and three per year per patient. Messages from patients to healthcare providers have doubled since the pandemic, from an average pace of 2.2 per year in early 2020 to 5.4 per year in late 2025.

“Our study shows that use of patient portals, health apps, and messaging are now a routine part of everyday patient care across America, not simply side channels used occasionally,” said study senior investigator Michal A. Mankowski, PhD.

Dr. Mankowski, an assistant professor in the Department of Surgery at NYU Grossman School of Medicine, said the study demonstrates that patients now have much more direct access to physicians and other clinicians.

“Our findings reveal that while digital health tools have become a core part of healthcare, delivery is becoming more continuous, timeless, and no longer tied to scheduled appointments during routine work hours,” said Dr. Mankowski.

Among the study’s other findings was that since 2020, Americans have, as logged in Epic record systems, booked at least 1.77 billion in-person visits to health clinics, sent 1.34 billion messages to their healthcare providers, and received some 3.25 billion online portal messages from providers. Also documented in Epic were 1.59 billion telephone calls and 146 million virtual telehealth portal visits.

Study co-investigator Dorry L. Segev, MD, PhD, said that the digital delivery of healthcare does not replace the old ways of working; it just adds another layer of more steps to existing workflows. To manage this new patient reality, hospitals, clinics, and healthcare workers have to plan future staffing and support.

“Modern delivery of healthcare means increasingly that healthcare providers will have to balance their digital workload on top of their traditional clinical workload,” said Dr. Segev, a professor and vice chair in the Department of Surgery at NYU Grossman School of Medicine. “Clinical staff will need to be trained in mastering the tools of messaging in healthcare; in using AI support programs, including chatbots that can frame content to minimize its complexity; and in making the most effective use of clinician time needed for online billing and online counseling,” said Dr. Segev, who is also a profession in NYU Grossman’s Department of Population Health.

Already, he noted, NYU Langone uses AI support tools to speed up drafting of physician and provider notes.

Dr. Segev said the team next plans to look more specifically at digital-use trends within healthcare systems, including NYU Langone, to break down any regional and outpatient clinic-specific shifts that could affect operational planning.

For the study, the team used Epic Cosmos, a national dataset of the electronic health records of more than 300 million American patients. The dataset includes information from a majority of hospitals and clinics that use Epic, the nation’s largest vendor of electronic health record systems, which had no role in performing the study.

Funding support for the study was provided by NYU Langone.

Along with Drs. Mankowski and Segev, NYU Langone researchers involved in the study were lead investigator Jane J. Long, MD, and co-investigators Mara A. McAdams DeMarco, PhD; Mark D. Schwartz, MD; Joshua Chodosh, MD; and Eric K. Oermann, MD.

Dr. Mankowski was recently elected to serve on the governing board of Epic Cosmos. Dr. Schwartz reported being president-elect of the Society of General Internal Medicine. Dr. Segev has received consulting and/or speaking honoraria from Sanofi, CareDx, Moderna, AstraZeneca, Roche, Optum, OrganOx, Hansa, and Biosidus and is a journal editor for Springer. None of these activities are related to the current JAMA study. NYU Langone is managing the terms and conditions of these relationships in accordance with its policies and procedures.

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About NYU Langone Health

NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 118 comprehensive academic medical centers across the nation for four years in a row, and U.S. News & World Report recently ranked four of its clinical specialties No. 1 in the nation. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 330 outpatient locations in the New York area and Florida. The system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise.

Media contacts:

At NYU Langone Health

David March

David.March@NYULangone.org

212-404-3528

Casey Nicholl (on June 22 only)

Casey.Nicholl@NYULangone.org

646-983-4920

Shira Polan (before and after June 22)

Shira.Polan@NYULangone.org

At DKC News

NYUResearch@dkcnews.com

Study DOI

10.1001/jama.2026.8690

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Journal

JAMA

DOI

10.1001/jama.2026.8690 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Trends[JR1.1] in Patient Portal Messages, Office Visits, and Telephone Encounters

Article Publication Date

22-Jun-2026

COI Statement

Funding support for the study was provided by NYU Langone. Along with Drs. Mankowski and Segev, NYU Langone researchers involved in the study were lead investigator Jane J. Long, MD, and co-investigators Mara A. McAdams DeMarco, PhD; Mark D. Schwartz, MD; Joshua Chodosh, MD; and Eric K. Oermann, MD. Dr. Mankowski was recently elected to serve on the governing board of Epic Cosmos. Dr. Schwartz reported being president-elect of the Society of General Internal Medicine. Dr. Segev has received consulting and/or speaking honoraria from Sanofi, CareDx, Moderna, AstraZeneca, Roche, Optum, OrganOx, Hansa, and Biosidus and is a journal editor for Springer. None of these activities are related to the current JAMA study. NYU Langone is managing the terms and conditions of these relationships in accordance with its policies and procedures.

 

Underwater expedition charts seaweed forests in the remote waters of southern Patagonia

Pensoft Publishers

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Marine expedition to Bahía Inútil (Intuil Bay).

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Credit: James Alfaro

At the icy, wind-swept tip of South America lies Inútil Bay, a remote marine environment in the Tierra del Fuego archipelago that has long guarded its underwater secrets due to severe logistical and meteorological challenges. A multi-institutional team of researchers have successfully conducted the first comprehensive exploration of the intertidal and subtidal rocky ecosystems of Inútil Bay.

The expedition, supported by the Marine Program of Rewilding Chile, brought together specialists from CADIC-CONICET and the Universidad Nacional de Tierra del Fuego (Argentina) to conduct the first survey of benthic macroalgae in a region that had never been systematically studied before.

The findings from this survey, recently published in the Biodiversity Data Journal, provide a missing piece in the biogeographical puzzle of sub-Antarctic coastal environments. Benthic marine macroalgae act as important ecosystem engineers, modifying the physical structure of coastal habitats to create complex environments that support rich marine food webs and exceptionally high levels of biodiversity.

Beyond their role as local habitat providers, these extensive algal communities contribute significantly to global climate mitigation, while also serving as sensitive indicators of environmental health and human-induced disturbances.

Operating across six distinct sampling locations along both the northern and southern coasts of the Inutil bay, the research team deployed scientific diving techniques, including the use of 25-metre line transects and photo-quadrats to document all macroalgae species distributions.

This field methodology culminated in the documentation of 72 distinct macroalgal taxa, providing a major expansion of the known phytogeographic characterisation of the Magellanic region (Chile). The survey recorded 32 taxa in the variable intertidal zone and 58 taxa in the subtidal depths, comprising a diverse assortment of green, brown, and red algae.

While canopy-forming kelp species such as Macrocystis pyrifera and Lessonia flavicans dominated the underwater landscape alongside widespread species like Ptilonia magellanica, the researchers also catalogued rare and highly unusual specimens, for example, Microzonia velutina, a little brown macroalga. 

All collected specimens are preserved at the Rewilding Chile Herbarium in Puerto Varas, ensuring that this dataset remains available to support future monitoring of these ecosystems, the detection of invasive species, and conservation planning in southern Patagonia.

At the same time, we are making progress on a collaborative alliance with the National Museum of Natural History of Chile, where we have already deposited an icefish larva (Champsocephalus esox) collected on a previous expedition and the Microzonia velutina.

The Research Team

Original source:

Kaminsky J, Palacios M, Rodríguez M, Hüne M (2026) Sub-Antarctic subtidal and intertidal macroalgae in rocky ecosystems of Inútil Bay, Tierra del Fuego in Southern Patagonia. Biodiversity Data Journal 14: e183377. https://doi.org/10.3897/BDJ.14.e183377

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Journal

Biodiversity Data Journal

DOI

10.3897/BDJ.14.e183377 

Method of Research

Survey

Article Title

Sub-Antarctic subtidal and intertidal macroalgae in rocky ecosystems of Inútil Bay, Tierra del Fuego in Southern Patagonia

Microzonia velutina - a brown algal species.

Marine expedition at Intuil Bay.

Marine expedition at Intuil Bay.

Credit

Mariano Rodríguez

 

Newly described Australian ballista spider builds a spring-loaded snare to catch a single ant species

In an unprecedented example of hunting specialization, this nocturnal rainforest spider has evolved a silk-powered snare that targets just one species of ant, launching its prey into the air with astonishing power and speed

Macquarie University

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A ballista spider (Propostira sp.) waits for a green tree ant (Oecophylla smaragdina) to bite the cone of its web and thus spring the snare

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Credit: Professor Ajay Narendra et al

An international team of researchers have discovered a remarkable new spider species in the rainforest of north Queensland that spins an ingenious and powerful spring-actuated snare to catch a single species of ant – one ant at a time – in what they describe as “the ultimate specialisation”. 

Nicknamed the ballista spider after the ancient Roman weapon that used a spring to launch a bolt or stone, the small nocturnal spider has apparently evolved a unique web mechanism to trap only the highly territorial and aggressive green tree ant Oecophylla smaragdina. 

A detailed description of the spider’s predatory strategy and mechanics is published in the latest issue of the journal Current Biology. The spider – which is yet to be formally named but belongs to the genus Propostira – was first observed by Professor Greg Anderson, a biomedical research scientist who is also a spider taxonomist and photographer. 

Lead researcher Professor Ajay Narendra of Macquarie University and postgraduate student Pranav Joshi then spent 10 days and nights in rainforest near Cooktown in far north Queensland locating the spiders, observing them in detail and capturing their behaviour using high-speed and infrared cameras. 

“It’s very unusual for a spider to feed on ants, because they’re notoriously dangerous, and even more bizarre to find a spider that eats only one particular ant species,” said Professor Narendra. “Ants have a range of chemical defences – including the ability to sting in some species – and they use alarm signals to rapidly recruit hundreds and even thousands of other ants as backup to overcome potential predators.” 

During the day, the ballista spider takes refuge on the underside of a leaf above an area where green tree ants are actively foraging. As night falls, the spider descends 50cm or more to lay an anchor point on a leaf, a branch, or the forest floor, then spends up to four hours engineering a vertical arrangement of 15-60 silk tension lines bundled together in a cone near the ground. 

As a final step, the spider wraps the cone with a thinner type of silk then rapidly retreats upwards. Within seconds, a green tree ant is attracted and reacts aggressively, biting the cone and detaching it from the anchor point. 

With the snare thus sprung, the ant is launched more than 30cm upwards into the spider’s core web at an acceleration of more than 1300 metres per second2. The spider waits for the ant to be fully entangled in its web before approaching and wrapping it with silk. 

“We suspect during the final construction stage the spider adds a pheromone that specifically lures worker ants and induces an aggressive attack, triggering the snare,” said Professor Narendra. “This seems to be the only case where a spider’s web is designed to catch a single prey species, and where the mechanism is triggered by the prey rather than by the predator.” 

Co-senior author Dr Jonas Wolff, who studies biomechanical properties of spider silk, travelled to Australia to observe the spider in the wild and took samples of its silk back to his lab at the University of Greifswald in Germany for detailed physical analysis, including scanning electron microscopy. 

“The ballista spider’s snare is bioengineered to store elastic energy in the silk and rapidly release it, giving it incredible instantaneous power density – greater than any other specialised silk-based biological catapults,” said Professor Narendra. “The ants it preys on have adhesive pads on their feet, so the contraction of the bundle of tension lines has to overcome a force of many times the ant’s body weight to lift it.” 

“The snare mechanism seems to have evolved as a highly specialised way of allowing the spider to ‘pick off’ potentially hazardous prey one at a time and transport them a safe distance away from ant trails and nests.” 

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Journal

Current Biology

DOI

10.1016/j.cub.2026.04.066 

Method of Research

Observational study

Subject of Research

Animals

Article Title

Ballistic high-powered spider webs overcome dangerous prey defenses

Article Publication Date

22-Jun-2026

 

Australia must tackle unemployment to reduce suicide rates

Adelaide University

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More than 3000 Australians die by suicide each year, yet one of the strongest known drivers of suicide risk – unemployment – remains largely overlooked in Australia’s suicide prevention programs.

Now, Adelaide University researchers are calling for a fundamental shift in how suicide is prevented, arguing that work, unemployment and financial insecurity must be recognised as critical factors in Australia’s suicide prevention response.

Funded by the Medical Research Future Fund’s Million Minds Mental Health Research Mission, the two-year Work and Unemployment: Vital to Effective Suicide Prevention project investigated how government policy, employers, suicide prevention networks, healthcare professionals and social security systems can contribute to reducing suicide risk.

In their final report presented today, researchers say Australia cannot significantly reduce suicide rates without addressing the social and economic conditions that place people at risk, including unemployment, financial hardship, insecure work, income instability and workplace distress.

The findings are particularly relevant with the Australian Government’s recent overhaul of the JobSeeker system.

“Work and unemployment are among the most important social determinants of suicide, yet they remain largely overlooked in suicide prevention,” Adelaide University Chief Investigator Associate Professor Toby Freeman said.

“Our research indicates that key aspects of Australia’s welfare system, including low support payments, mutual obligations and punitive approaches to employment services, can increase financial hardship, social exclusion and psychological distress, all of which are associated with elevated suicide risk.

“We also found workplace factors such as job insecurity, psychosocial hazards, poor working conditions and power imbalances can contribute to suicidal distress, despite often being overlooked in suicide prevention efforts.

“Too often, responses to suicide risk focus on the individual while overlooking the social and economic circumstances that may be contributing to that distress.

“If someone is struggling because they’ve lost their job, can’t afford housing or are facing severe financial hardship, medication alone will not address the underlying causes of their distress.

“And while mental health services are critically important, factors such as poverty, unemployment, financial insecurity, housing stress and poor working conditions can profoundly affect a person’s wellbeing and suicide risk.”

According to data from the Australian Institute for Health and Welfare, people on unemployment payments are 2.8 times more likely to die by suicide, with more than 600 unemployed people dying by suicide each year in Australia.

The Adelaide University research included analysis of employment, social security and health policies, reviews of existing evidence, analysis of suicide coronial data, and interviews with policymakers, employers and suicide prevention stakeholders across Australia.

“There’s also a disconnect in government policy. While suicide prevention strategies increasingly recognise the importance of social and economic factors, employment and social security policies often fail to consider their potential impact on suicide risk,” Assoc Prof Freeman said.

“Beyond government and workplaces, we found that local Suicide Prevention Networks are making an important contribution in communities across Australia, but their role in addressing the social determinants of distress remains under-recognised and under-supported.

“If we are serious about reducing suicide in Australia, we need to move beyond treating distress and place greater emphasis on addressing the conditions that place people at risk in the first place.”

The project has produced a series of recommendations for governments, employers, suicide prevention organisations and healthcare providers, including stronger recognition of employment-related risk factors, greater cross-sector collaboration, improved support for local suicide prevention networks, and increased attention to the social determinants of suicide.

Key recommendations include:

• Recognise work and unemployment as critical factors in suicide prevention and better integrate suicide prevention into employment and social security policy.
• Address workplace factors that contribute to suicidal distress, including job insecurity, psychosocial hazards, poor working conditions and workplace power imbalances.
• Raise JobSeeker payments to a liveable level and replace punitive mutual obligations and workfare programs (such as Work for the Dole) with supportive employment services that help people find meaningful and secure work.
• Ensure employment programs for remote Aboriginal and Torres Strait Islander communities are co-designed with local communities.
• Expand suicide prevention beyond clinical interventions to address social and economic drivers of distress, including unemployment, poverty, housing insecurity and financial hardship.
• Strengthen support for community-based Suicide Prevention Networks and improve training for healthcare professionals, employment services staff and workplaces to better recognise and respond to social determinants of suicide.
• Strengthen collaboration between governments, employers, health services and community organisations to address the upstream causes of suicide risk.

“We cannot treat our way out of this problem. Reducing suicide in Australia requires action long before people reach crisis point,” Assoc Prof Freeman said.

“Greater attention must be paid to the role that unemployment, insecure work, financial insecurity and social exclusion play in people's lives.

“If we continue to overlook these factors, we will continue to miss opportunities to prevent suicide and save lives.”

The Work and Unemployment: Vital to Effective Suicide Prevention project was led by Adelaide University’s Assoc Prof Toby Freeman, with Dr Miriam van den Berg, Prof Jon Juredini and Dr Matt Fisher, in partnership with the Australian Unemployed Workers Union, South Australian Council of Social Service, Anti-Poverty Network SA, Healing Centre for Griefology, Suicide Prevention Australia and Wesley Mission.

Project findings will be presented on Monday 15 June at 2:30-4:30pm (ACST) in the Joe Verco Lecture Theatre | G033, Adelaide Health and Medical Sciences Building, North Terrace, Adelaide.

 

Microbes frozen in ancient rubbish heaps help reconstruct ancient Greenlanders’ farms, seal hunts, and toilets

Microbiome of ancient middens sheds new light on the daily life of Paleo-Inuit and old Norse

Frontiers

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The authors during their fieldwork on Greenland

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Credit: Louise Hindborg Mortensen

Greenland has a long and checkered history of human settlement: several Paleo-Inuit cultures since approximately 2,500 BCE, descendants of Vikings between the tenth and fifteenth centuries, and early modern Danes since 1721. All left their traces on the landscape, for example in the form of ancient domestic rubbish heaps. Composed of waste like animal bones, excrement, mollusk shells, and human artefacts, these middens are a precious resource for archaeologists.

But what can microbiologists contribute to the study of these middens, for example revealing which diseases plagued historic populations, and which animals they kept but perhaps didn’t eat? And now that the Arctic is warming three to four times faster than the global average, could thawing middens be a source of resurgent infectious diseases?

“Here we show that the risk of release of ancient pathogens from ancient middens on Greenland is currently low,” said Dr Frank Møller Aarestrup, a professor at the National Food Institute of Denmark Technical University and corresponding author of the article in Frontiers in Microbiology. “Rather, we found that these middens in the cold Arctic acted like long-term natural experiments. Human- and animal-associated bacterial signals, including opportunistic bacteria and bacteria carrying antibiotic resistance genes, have remained detectable in them many centuries later as the legacy of human activity: for example, livestock farming by the ancient Norse.”

Studying the dustbins of history

In 2020 and 2021 in West and South Greenland, Aarestrup and colleagues collected samples from several middens frozen in time by permafrost and covering 4,500 years of human life in Greenland. These had been identified by the Greenland National Museum and Archives registry. At ancient Norse sites, for example at Kapisilit and Narsarsuaq, they also collected soil samples from historic winter enclosures and summer grazing grounds for livestock. The researchers used DNA sequencing to reconstruct entire bacterial communities. They compared their findings to those in 143 soil samples from areas of permafrost distant from any historical settlements.

The sequencing revealed between 9 and 202 bacterial species per midden, for a total of 1,207 species. Importantly, many of these species were previously undescribed and could only be assigned to broad taxonomic categories like families and orders. “This […] highlights how poorly described Arctic soils and archaeological deposits remain,” wrote the authors.

Middens had significantly richer bacterial communities than surrounding pristine soils, confirming that they preserved the biological legacy of human activity. Middens from the Paleo-Inuit had the most soil-like bacterial communities, indicating that the microbial imprint from humans and animals diminishes over time.

Groups of bacteria known to live on or within animal and human hosts predominated in most middens. These included harmless bacteria from human feces like Clostridium massilliamazoniense, Clostridium baratii which can cause botulism, and Paeniclostridium sordellii, which can cause life-threatening human diseases like toxic shock syndrome, sepsis, and gas gangrene.

Bacterial communities depended strongly on the type of waste material in each midden. For example, those from early colonial era Nuuk contained decomposing seal skins and were rich in the bacterium Clostridium perfringens, a major cause of food poisoning. Romboutsia species and Paraclostridium sordellii – which live in the gut of many animals – were abundant in middens filled with animal carcasses, while early Norse middens with decomposing bones were rich in unknown species of Proteobacteria and Clostridiaceae.

No reason to worry

The authors also found a great diversity of genes associated with antimicrobial resistance in bacterial genomes from middens. The presence of the same genes in ancient and contemporary soil layers signaled that microbes resistant to antimicrobials can linger in permafrost for centuries. However, the authors concluded from the spatial distribution of these pathogens that they don’t spread far from thawing middens. They thus appear to pose little risk to public health – at least for now.

"The microbiome in thawing permafrost appeared to be rapidly replaced by local contemporary environmental microbes once released into run-offs,” observed co-author Dr Saria Otani, an associate professor at the National Food Institute.

“However, it is not known whether the risk of release of pathogens will increase with increasing temperatures, or whether this might be greater in other Arctic regions. For this reason, it would be prudent to include microbiome characterization as a routine monitoring aspect during archaeological visits," counseled last author Dr Anders Priemé, a professor at the University of Copenhagen.

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Journal

Frontiers in Microbiology

DOI

10.3389/fmicb.2026.1809037 

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Microbial composition of archaeological middens: Tracing Human Footprints Through Centuries in Greenland's Ancient Settlements

Article Publication Date

17-Jun-2026