Online messages have become a lynchpin of many patients’ relationships with their doctors.

The digital access points—often baked into patient portals and electronic health record systems like Epic’s MyChart—offer patients the opportunity for quick clarifications about their medication regimen or test results. In more pressing cases, a back-and-forth with their clinician can help patients understand whether their symptoms require an in-person visit or can be managed at home, potentially lightening the load on busy providers.

As the requests pile up, however, many systems have found that the missives can claim a substantial portion of their practitioners’ valuable time. As such, some organizations have announced billing policies that charge patients a fee for certain electronic messaging to providers.