Patient portal messages surge; cancer survivors and primary care; Fauci subpoenaed — Morning Medical Update

Patient portal messages surge

The jump is adding to clinician workload, and editorialists say health systems should build inbox time into schedules.

Patient-authored messages through electronic health record portals rose from 0.99 per patient per year in 2020 to 2.5 in 2025, a more than 150% jump, according to an analysis of Epic Cosmos data published in JAMA by Michal Mankowski, Ph.D., of New York University Grossman School of Medicine, and colleagues. The messages do not appear to be replacing other care: office visits rose 17% over the same period and telephone encounters fell just 6%.

In an accompanying editorial, Melanie Molina, M.D., and Joseph Ross, M.D., called the trend a “structural change in care delivery” and urged health systems to factor message volume into staffing models and carve out dedicated inbox time, warning that inaction shifts uncompensated, after-hours work onto clinicians. Researchers who study portal messaging as a driver of burnout pointed to protected scheduling blocks, team-based triage, AI-drafted replies and reimbursement as possible fixes.

Cancer survivors and primary care

Four federally funded trials target the gaps clinicians face as more cancer survivors land in primary care.

More than 18 million people in the United States are living with a history of cancer, and more than 60% receive at least some care from primary care clinicians, who often lack a systematic way to flag a cancer history in the electronic health record or clear guidance on follow-up. To address those gaps, the National Cancer Institute is funding a coordinated set of four randomized controlled trials under the Primary Care Engaged Research for Cancer Survivorship Care (PERCS) initiative, outlined in the Annals of Family Medicine by Michelle Mollica, Ph.D., and colleagues.

Running in New Jersey, Florida, Kansas and Texas, the studies span more than 30 clinics and 6,000 adult survivors across rural and urban settings, including federally qualified health centers, and test practice- and system-level fixes such as redesigned workflows, EHR enhancements, team-based care and clinician telementoring. The trials share a focus on delivering guideline-concordant care and keeping patients from getting “lost in transition” between oncology and primary care. Results are pending, but the initiative reflects a broader push to treat survivorship as part of longitudinal primary care rather than a discrete oncology hand-off.

Fauci subpoenaed

The committee chair compelled the former NIAID director to appear in July after he declined to testify voluntarily.

Sen. Rand Paul (R-Kentucky), chair of the Senate Homeland Security and Governmental Affairs Committee, has subpoenaed Anthony Fauci, M.D., to testify at a public hearing in July, escalating a yearslong dispute over the origins of COVID-19. Paul said he issued the subpoena after Fauci, the former director of the National Institute of Allergy and Infectious Diseases, declined to appear voluntarily despite previously agreeing to do so.

Paul said he wants to question Fauci about federal funding for COVID-19 research at the Wuhan Institute of Virology, the handling of records and the preemptive pardon former President Joe Biden granted Fauci in January 2025. The subpoena follows the release of declassified documents by outgoing Director of National Intelligence Tulsi Gabbard, who said they raise questions about Fauci’s role in the government’s review of the virus’s origins.

Fauci has repeatedly denied misleading Congress and disputed that NIH-funded work met the federal definition of gain-of-function research.