Rather than just getting more cheerleading for a technology that has been disappointing for years, attendees at the AMIA annual conference on Tuesday heard a refreshingly frank assessment of the slow uptake of personal health records.

[See also: For portals, speak patients' language]

But they also heard about strategies informaticists can use to better employ PHRs to engage patients and clinicians alike. And they got to hear from activist patients and caregivers for an often-overlooked perspective.

Noting that the meaningful use regulations to date have not specified a preference for PHRs or patient portals when it comes to making records available to consumers or engaging patients, Joseph Kannry, MD, lead technical informaticist at Mount Sinai Health System in New York City, said no institution wants to put up multiple portals.

[See also: Smart data key to patient engagement]

He also discussed a paradox: Sick patients are most in need of being engaged with a tool like a PHR, but, "the sicker they get, the less likely they are to use it."

Jessica Ancker, just promoted to associate professor of healthcare policy and research at Weill Cornell Medical College in New York, showed another raw fact: Even as physician adoption of EHRs has soared, PHRs and portals alike remain underutilized.

Research Ancker has conducted herself showed that just 17 percent of patients in New York State were active users of portals in 2013. Although that's up from 11 percent in 2012, it is far behind the national physician EHR use of 78 percent last year, according to CMS data. Nationally, Ancker said, the California HealthCare Foundation reported 7 percent portal adoption as recently as 2010.

Other published research that Ancker discussed showed a perceived lack of value in PHRs and portals alike. One study found no clear pattern of better outcomes in patients actively using PHRs, though another showed that such patients saw primary care physicians more often than nonusers. PHRs helped with medication reconciliation, one study concluded, though another found no improvement in control of hypertension.

"Results have been a little mixed and certainly not a real home run," Ancker said.

"There's some hope that they could improve patient motivation by strengthening the patient-provider relationship," she added -- however, "there hasn't been a coherent model for what this is going to do."