Emoji Usage In Electronic Health Records Increasing

A talisman of current culture, the emoji, is increasingly found in patients' electronic records.  Does it improve or interfere with the accurate, quick conveyance of information?

https://www.michigandaily.com/news/research/michigan-medicine-study-shows-emoji-usage-increasing-in-electronic-health-records/

Michigan Medicine study shows emoji usage increasing in electronic health records
By Sarayu Bongale - March 29, 2026

A Michigan Medicine study published Jan. 14 analyzed 218.1 million clinical notes from 1.6 million patients’ electronic health records and found that both clinicians and patients used emojis more often in medical records from January 2020 to September 2025. Out of all the notes analyzed during this time period, 372 distinct emojis appeared across 4,162 notes from both patients and health care professionals.

In an interview with The Michigan Daily, David Hanauer, clinical associate professor of pediatrics and learning health science at Michigan Medicine, said the idea originated from him noticing emoji use in electronic health records and wanting to raise awareness about the increased usage.

“It was mostly out of interest, just trying to explore if anything was there at all,” Hanauer said. “Our understanding had been that emojis and other symbols are actually not supposed to be used in a medical record, so we were wondering: Were there any there at all, and how often were they being used, and which ones?”

Hanauer said the growing use of diverse emojis in EHRs risks misinterpretation and confusion.

“Most of the concerns that people have is that it’s hard to understand from an emoji what is being conveyed,” Hanauer said. “Maybe a smiley face is pretty obvious to most people, but there’s a lot of different faces with nuances and other symbols. I think there can be a lot of miscommunication, misinterpretation.”

In an interview with The Daily, Kim Ford, health information business systems analyst lead on the revenue cycle mid-service team at Michigan Medicine, said the risk of misinterpretation increases across age groups, as different generations may understand and use emojis in different ways.

“If you have older patients who may not be familiar with emojis, it’s almost like a foreign language to them,” Ford said. “(For) our younger generation — or those people that have grown up with technology — it’s a second language for them that they understand very well. That’s my biggest concern.”

Hanauer said the growing variety of emojis may present a barrier to communication specifically for individuals with poor eyesight

“For older people, having small emojis might actually be hard for them to see and make out, so they might see its face but they can’t tell what the specific expression is,” Hanauer said. “I think we found over 300 different kinds of emojis being used. That’s a lot of different symbols that people would have to understand what they mean.”

Hanauer said he worries emoji misinterpretations can lead to bad patient care outcomes.

“We hope that doesn’t happen, but I think because of that concern, there’s probably going to be a little bit more oversight ,” Hanauer said. “I don’t think we would easily be able to find a circumstance in which there was actually some sort of better or negative outcome from an emoji being misinterpreted.”

LSA sophomore Leah Beel, a medical assistant at American Family Care in Ann Arbor, told The Daily she believes that the EHRs are supposed to be objective and emoji usage detracts from that.

“From my experience, EHRs are used to get quick information and try to communicate with each other in a fast and reliable way,” Beel said. “The only thing I would use is an exclamation point, which, even then, is kind of out there. It’s a good thing that emojis can show enthusiasm or certain reactions, but I also think to a degree — it’s not unprofessional but just someone might take it the wrong way. My perspective on EHR is that you write very objectively.”

Elizabeth Rossmann Beel, a pediatric anesthesiologist at Texas Children’s hospital, said emojis can be an easier way for health care professionals to communicate.

“It’s a way to react to something without putting as much effort into it, or into making that person who’s reading it feel like they need to reply,” Rossmann Beel said. “I think it can cut down a little bit on the burden of replying to and responding to messages in the EHR, which is nice. However, it’s definitely more casual, and so sometimes that’s not the best tone to be setting in a medical record.”

Ford said she plans to use the information from this study to learn more about the impacts of emojis on patient outcomes and potentially create regulations.

“Maybe emojis are an acceptable means of communication,” Ford said. “The other piece is, should there be a governance process around what emojis can be used? And in what situations? I need to think a little bit about what their structure might look like — what department should be involved in reviewing and approving those, what should be the process to submit an emoji for consideration for use? There’s a lot of pieces to the governance process that need to be figured out there.”