Emoji Use Found Inside Medical Records Is Raising Concerns About Professionalism
Emoji use is no longer limited to casual texts and social media posts. New research suggests these digital symbols are quietly making their way into electronic health records, sparking debate among clinicians about clarity, professionalism, and patient understanding.
Large Study Examines Emoji Use in Clinical Notes
A recent research letter published in a major medical journal analyzed emoji use within electronic health records from Michigan Medicine. The study reviewed 218 million clinical notes linked to 1.6 million patients over a five-year period.
Researchers identified 372 different emojis appearing in just over 4,000 notes. While that represents a small fraction of total records, the findings suggest emoji use is more common than previously believed, especially compared with earlier studies that focused only on clinical messaging tools.
Where Emojis Are Showing Up Most Often
Emoji use was most frequently found in patient-facing communications. Around one-third of emoji-containing notes were patient portal messages, followed by telephone messages, encounter summaries, progress notes, and patient instructions.
Interestingly, patients themselves could not add emojis through the University of Michigan’s patient portal, meaning the symbols were introduced entirely by clinicians or staff.
The most commonly used emoji was the smiling face with smiling eyes, appearing more than 1,700 times. Practical symbols such as the telephone receiver and calendar were also widely used, suggesting emojis may be serving functional as well as emotional purposes.
Confusion Over Emoji Meanings
The study included an illustration of the 50 most commonly used emojis along with their official names. Even experienced users may struggle to match the visuals with their formal definitions.
Some symbols raised questions about interpretation. The briefcase emoji, for example, could be mistaken for a doctor’s bag. Others, such as busts in silhouette or bar of soap, may feel outdated or ambiguous to modern users. Researchers also noted uncertainty around symbols like the pushpin, blue diamond, and “P” button, particularly in a medical context.
One emoji raised particular concern despite being rarely used: the police car light, which could easily be misinterpreted or alarm patients.
Older Patients Are Using Emojis Too
While emoji use was highest among younger patients, individuals in their 70s ranked second in usage frequency. This raised concerns about potential misunderstandings, especially among older patients who may interpret symbols differently or be less familiar with evolving emoji meanings.
The researchers warned that emojis, while playful, carry a risk of confusion when used in healthcare settings. They urged healthcare organizations to develop clear guidelines to ensure professionalism and avoid miscommunication.
Legal and Professional Concerns Remain
Some clinicians note that emojis may pose risks because patient portals are part of the legal medical record. Symbols can be interpreted differently by patients, providers, lawyers, or regulators reviewing records years later.
Although emoji use may be prohibited under some institutional policies, enforcement and awareness appear inconsistent. Some clinicians acknowledge that emojis can help build rapport with pediatric or teenage patients, but caution that any message relying on an emoji to convey meaning should instead use clear language.
A common recommendation is simple: if removing the emoji changes the meaning of the message, the emoji should not be used alone.
Previous Research Paints a More Positive Picture
Earlier studies focusing on clinician-to-clinician messaging have found fewer issues. A 2023 study examining secure messages between hospital staff found that emojis and emoticons were mainly used to express emotion or maintain communication flow. Researchers found no evidence that they caused confusion or appeared unprofessional in that context.
This contrast highlights an important distinction. Communication between clinicians often includes jargon and shorthand, while patient communications are expected to meet a higher standard of clarity and accessibility.
The Bigger Question: Do Emojis Help or Hurt?
The authors of the new study emphasized that tracking emoji use is only a first step. Future research will need to examine how emojis affect patient understanding, trust, satisfaction, and health outcomes.
As artificial intelligence tools increasingly assist clinicians in drafting messages, questions have also emerged about whether some emojis may be added automatically rather than intentionally.
For now, healthcare leaders are left with an open question. Emojis may offer warmth and relatability, but without clear guidelines, they could also introduce confusion into records meant to be precise and legally sound.
As digital communication continues to evolve, hospitals and clinics may soon need to decide whether emojis belong in medical records at all, or whether words alone remain the safest choice.
