The EHR may have the reputation for being an informationally dense and often joyless place, but new research finds that a handful of emoji are scattered throughout the millions of notes inside like tiny digital pick-me-ups.
The study, recently published in JAMA Network Open™, shows the top 50 emoji used in the EHR, and also gives background about how they were introduced. Researchers checked 218.1 million EHR notes created between Jan. 1, 2020, and Sept. 30, 2025, finding that 4,162 notes contained 372 distinct emoji, which are small representative digital images familiar from their widespread use in text messages and on social media.
Of the top 50 most commonly used emoji, 12 were circular yellow faces. In fact, 59.5% of all the emojis expressed emotion or feeling, as opposed to being for informational or symbolic use. Some of the emoji were clearly medical in nature—for example, pills, stethoscopes, hospitals and test tubes—but a handful were more esoteric. There was the maple leaf, perhaps a reference to fall or fall risks, and cooked rice, which could indicate the first-aid protocol RICE (rest, ice, compress, elevate) or the short-term BRAT (bananas, rice, applesauce, toast) diet. In one case, at least, the rice emoji referred specifically to instructions for the creation of a hot compress using rice.
Roughly one-quarter of the EHR notes contained more than one emoji. Among the EHR notes that contained them, the most commonly used emoji were those that displayed:
- Smileys or emotion—58.5%.
- Objects—21.2%.
- People or bodies—17.6%.
- Symbols—11.9%.
- Animals and nature—10.6%.
- Travel or places—8.9%.
- Food and drink—3.4%.
A small number of emoji were of activities, flags or component emojis, which are used to modify other emojis. Researchers were able to identify the emoji’s intended function within the note in all but one case.
Use emoji with care
Audiey Kao, MD, PhD, vice president of ethics at the AMA, said although there are no specific ethical restrictions on the use of emoji in the EHR, physicians and other members of the care team should always err on the side of “first, do no harm.”
Dr. Kao said the emoji used should be clear, avoiding ones “that can be misinterpreted, especially among patients who may have low digital literacy” or that might “label a patient as difficult.”
The study’s authors noted similar concerns, writing that “emoji interpretations may differ by age group, and notable concerns exist regarding their use among older adults, although findings are mixed.”
Who gets the emoji?
The study, “Emoji Use in the Electronic Health Record,” was written by David A. Hanauer, MD, MS; Gavin C. Raab; Shira N. Hanauer; Lisa Ferguson, MS; Kellen McClain; Guan Wang, MS; Michelle Rozwadowski, and Sung W. Choi, MD, MS. They found that patients and their families were often the intended recipient of the emoji-containing note. In 35% of cases, the note was meant for another member of the clinical care team, which could also include school counselors and employees at health-related nonprofits.
The patient age range with the highest rate of EHR notes containing an emoji was 10–19 years old, followed by 70–79 years old, 20–29 years old, and 80–89 years old, in descending order. The patient age range with the lowest rate of emoji in their notes was 0–9 years old.
The most common EHR notes containing emoji were portal messages to patients, followed by written notes of telephone encounters, encounter summaries, progress notes and patient instructions.
In 89% of the cases, the emoji was introduced by a physician or other member of the care team. The researchers noted that because their patient portal restricted patients from using emoji, none of the 34.5 million patient portal messages used any emoji (sad face). But some emoji snuck into the EHR from patients via copy-pasted emails, copied text messages or questionnaires uploaded to the portal.
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