The more digital health tools are adopted, the greater the disparities among at-risk populations, according to a study published in the Clinical Journal of the American Society of Nephrology.

Researchers examined about 2,800 patients at four university-affiliated nephrology offices in western Pennsylvania to assess their use of an EHR portal to manage their chronic kidney disease. The review included some 2,800 patients treated between Jan. 1, 2010, and Dec. 31, 2012, who all had at least one additional nephrology follow-up visit conducted before June 30, 2013.

Researchers used EHRs to obtain patients' clinical measurements, comorbidities, office visits and sociodemographic characteristics. About 40 percent of the study participants accessed the portal, with which they could communicate with providers, refill prescriptions, review laboratory results, review medications and schedule or change appointments. 

Study participants learned about the portal through fliers and pamphlets provided at the clinics, but they did not receive any training on how to sign up or use the portal. The top actions were reviewing laboratory results (87 percent), reviewing their medical information (85 percent) and reviewing or altering appointments (85 percent).

Those who used the portal were more likely to be enrolled in private insurance, married, white and younger. Meanwhile, those who did not access the portal were more likely to be black, enrolled in Medicaid or Medicare, lower-income, older and unmarried.

"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," said one of the authors, Khaled Abdel-Kader, MD, MS, of the Vanderbilt Center for Kidney Disease. "As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on."

Further research is needed to understand why vulnerable populations don't access patient portals, the authors concluded. "Future research should examine barriers to the use of e-health technologies in underserved patients with [chronic kidney disease], interventions to address them and their potential to improve outcomes."