Portals and personal health records have been touted as ways to spur better patient engagement and set the stage for improved outcomes. But a new study shows they often aren't used at all by the very people who may need them most.

The report, Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics, was published this month in the Clinical Journal of the American Society of Nephrology.

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"Electronic health record patient portals allow individuals to access their medical information with the intent of patient empowerment," researchers write. "However, little is known about portal use in nephrology patients."

The study tracked patients seen between Jan. 1, 2010, and Dec. 31, 2012, at four university-affiliated nephrology offices; each of the patients had at least one additional follow-up visit before June 30, 2013. Researchers abstracted sociodemographic characteristics, comorbidities, clinical measurements and office visits from the EHR and also tracked median household income for patients' neighborhoods for added context.

Of 2,803 patients, 1,098 (39 percent) accessed the portal. Of those, more than 87 percent of users reviewed their laboratory results, 85 percent reviewed their medical information, 85 percent reviewed or altered appointments, 77 percent reviewed medications, 65 percent requested medication refills and 31 percent requested medical advice from their renal provider, according to the CJASN study.

But in adjusted models, characteristics such as being older, being African-American, being insured by Medicaid or living in a neighborhood with lower median household income "were associated with not accessing the portal," according to researchers, who pointed to factors such as data security concerns or lack of confidence or skills in accessing health information online as potential barriers.

"While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it," the report concludes. "Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them and their potential to improve outcomes."

"Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable," Khaled Abdel-Kader, the study's lead author, told NPR. "As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on."

Access the study here.