Emojis in EHRs: minor detail or new trend?

Electronic health records (EHRs) aren't known for their whimsy. They're used to record symptoms, hypotheses, and decisions. Winks are rare. Yet, researchers at the University of Michigan are spotting emojis in clinical notes, according to a new article recently published in JAMA Network Open.Their analysis is based on records from a single university hospital, Michigan Medicine in Ann Arbor. It covers 218.1 million notes written between 2020 and 2025 for 1.6 million patients followed at that institution. In total, 372 distinct emojis were used in 4,162 notes.The phenomenon remains marginal. “Emoji usage rates remained relatively stable at 1.4 notes per 100,000 between 2020 and 2024, then increased to 10.7 per 100,000 in the third quarter of 2025,” wrote the authors, who say they have no explanation for this recent rise.Nothing exponential, then. But enough to raise a simple question: do these digital symbols have a place in EHRs?Primarily, they are used to punctuate a message, rarely to replace a clinical term. The researchers randomly analyzed 200 notes to clarify their usage. They found that 59.5% of the symbols express an emotion or feeling, compared to 40.5% that are informative or symbolic. In 57% of cases, the emoji appears alone, often at the end of a message. In 41.5%, it accompanies a word or instruction. It replaces a term in only 1% of situations.An image published in the study—which we reproduce here—shows the 50 most frequent emojis. The smiling face is by far the most common, followed by the telephone receiver, the calendar, and the no-go symbol. More unexpected icons also appear, such as the maple leaf or the bowl of rice.Most notes containing an emoji are intended for the patient or their family. In their press release, the authors emphasized that “although the use of emojis in medical records remains rare, it appears to be increasing, which raises important questions about differences in interpretation according to age and best practices for digital communication between clinician and patient.” In other words, these aren't disguised clinical abbreviations. They are primarily relational markers.A matter of interpretationThis is precisely where the subject ceases to be anecdotal. An emoji doesn't always have a single, unambiguous meaning. The authors reminded that "the interpretation of emojis can vary according to age groups." Studies cited in their article show that understanding differs depending on digital experience, culture, and context.In their analysis, messages containing an emoji are most often sent to teenagers aged 10 to 19. But the second most exposed group is the 70-79 age group. A detail that raises questions.The risk is not so much clinical as relational. A smile can be perceived as empathetic. Or condescending. A prohibition icon can clarify an instruction. Or seem abrupt. The medical record is no longer just a communication tool between professionals. It is also consulted by patients.The American Medical Association (AMA) has not issued a formal ban, but it does urge caution. Clinicians should avoid symbols "that can be misinterpreted" or that could "label a patient as difficult," emphasized Audiey Kao, AMA’s vice president of ethics. The issue then becomes simple: Is what is clear to the sender clear to the recipient?The CMQ frameworkIn Quebec, the question is not framed in terms of a ban on emojis. The Collège des médecins du Québec (CMQ) obviously does not address pictograms in its communications. However, it emphasizes principles that inform the debate.In its guide on document preparation and maintenance, the CMQ (College of Physicians of Quebec) emphasizes that legibility is essential and aims to reduce the risk of errors. Notes must be understandable to any other healthcare professional who may consult them. The College also stresses that the medical note is "the central element of the file" and must reflect the decision-making process. It must be clear, precise, and sufficiently comprehensive to ensure continuity of care. Poor record-keeping can lead to misunderstandings and hinder data retrieval.In light of these principles, the question is not whether an emoji is cute. It is whether it adds clarity or introduces ambiguity that could compromise the file's legibility.Between friendliness and rigor of documentationAt the end of the analysis, the use of emojis in electronic health records (EHRs) remains limited. However, their presence reflects a broader trend. The medical record is no longer solely an internal tool. It is read by patients, shared between teams, and analyzed by digital systems. Every word counts. Every symbol, too.However, the American study does not call for a ban on pictograms. Rather, it invites us to consider their effects: the clarity of the message, its reception, and its traceability. In an EHR, nothing is insignificant. Not even a smile 😉.ReferenceHanauer DA, Raab GC, Hanauer SN et coll. Emoji Use in the Electronic Health Record. JAMA Netw Open. 2 jan 2026;9(1):e2553770. ddoi: 10.1001/jamanetworkopen.2025.53770 This article was initially published on our sister site ProfessionSanté.ca and has been translated from its original French.

Emojis in EHRs: minor detail or new trend?

Register for free access or login.

Related Topics