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Over the past several months, in interviews with health care providers (HCPs) across multiple medical specialties, my team and I have been taking a closer look at how HCP conversations with patients and care partners are evolving. Traditionally and historically, those conversations happened exclusively in the exam room and over the telephone. Important parts of the HCP-patient information exchange also occurs with nurses or office staff before or after the visit.
But increasingly, a significant share of communication is happening somewhere else entirely: inside patient portals such as Epic’s MyChart.
For years, pharma’s understanding of the patient journey has centered on the office encounter in the exam room. It’s where diagnosis happens, where treatment decisions are discussed, and where most of our commercial models assume meaningful HCP-patient communication takes place.
But HCPs will tell you that the visit is now just the beginning. After the patient leaves the office, the conversation often continues digitally. Patients ask follow-up questions, share symptoms, upload test results, and request medication adjustments. Care partners -- spouses, parents, adult children -- join the thread. What once required another appointment now unfolds asynchronously in the portal.
For many practices, this is no longer a marginal activity. It’s a daily workflow.
Systems like Epic’s MyChart have transformed what used to be administrative messaging into something closer to a care delivery platform. HCPs review symptoms, clarify dosing instructions, discuss side effects, and sometimes make treatment adjustments -- all through portal messages.
At the same time, patients are increasingly utilizing these portals to access their own health data. Test results -- bloodwork, imaging reports, pathology findings -- often appear in the portal quickly, sometimes within hours. For patients and care partners, the speed and visibility can be empowering. They no longer have to wait for a follow-up appointment or a phone call from the office to see what the tests show.
Of course, that immediacy also creates new dynamics. Patients frequently can review results before speaking with their physician and may arrive at the portal with questions, interpretations, or concerns.
And patients are arriving with more information than ever before. Some of it comes from traditional health websites. Increasingly, it comes from AI tools, like ChatGPT, that patients use to interpret symptoms, lab values, or potential diagnoses. Physicians now find themselves responding not just to patient questions, but to analyses generated by algorithms.
The result is a new communication dynamic: more information flowing into the clinical system, more interpretation happening outside the clinic, and far more digital touchpoints between visits.
Health systems are already recognizing and responding to the operational challenge this creates. If physicians answered every portal message personally, many say they could spend their entire day doing so.
That’s why EHR companies are introducing AI-assisted messaging tools. Epic, for example, has launched capabilities that help HCPs draft or standardize responses to common patient questions. Other platforms, including Oracle Health (formerly Cerner), are working on similar solutions.
The goal is efficiency. AI can help summarize patient messages, suggest responses, or generate templated guidance that HCPs can quickly review and send.
In other words, AI is beginning to shape both sides of the conversation: patients using AI to generate questions, and HCPs using AI to respond at scale.
For those of us working in I&A, this raises an important question: How much of the patient journey is now happening in channels we rarely observe?
When we study HCP-patient communication, we typically focus on the exam room visit itself. Even sophisticated approaches -- like ethnography, office observation, visit recordings -- capture only the interaction that occurs in the clinic.
But a growing portion of care-related dialogue now takes place in the portal. Questions about side effects. Clarifications about dosing. Conversations about whether a therapy is working. Requests for refills or changes in treatment.
If we’re only studying what happens in the exam room, we’re likely missing a meaningful share of the communication ecosystem.
At the moment, the answers are not entirely clear. From a privacy perspective, these conversations are protected health information. Access will always be constrained by HIPAA and by health system privacy governance. At the same time, the growth and scale of portal communication implies that it is becoming an increasingly important component of the real-world patient journey.
That raises a few strategic questions we should be pondering:
These are not simple questions. But any serious understanding of the patient journey will have to account for it.
The patient portal has rapidly evolved from an administrative tool into a meaningful venue for care delivery and clinical dialogue. And AI is accelerating that shift.
For those of us in I&A who develop patient journeys, model treatment decisions, or study HCP-patient communication, it is high time to widen the lens.
The exam room still matters. But it is no longer the whole story.
I’m curious what others are seeing in their own research or clinical work. Are patient portals becoming a significant communication channel in your experience? And how should the life sciences industry think about engaging with this emerging layer of the care ecosystem?
