A study at Michigan Medicine analyzed 218.1 million clinical notes from electronic health records of 1.6 million patients between 2020 and 2025[1][3]. They identified 372 different emojis in 4162 notes, which is less than two notes per 100,000[1][3]. Emoji use is still rare but growing[1][2][3]. Most common were smiley emoticons (58.5%), followed by objects (21.2%) and people/body parts (17.6%)[3]. The most used were smile with smiling eyes (1772 occurrences), telephone receiver (544) and calendar (429)[3]. The majority of emojis were found in patient messages through the portal, around 41% were part of templates[2]. Emojis expressing emotions made up 60%, the rest were informative or symbolic[2]. The study highlights issues of interpretation, particularly in elderly patients, and recommends the development of guidelines for their use[2][3].