Millions of American veterans have registered to access their patient records on My HealtheVet, the VA’s patient portal, but actual use has been spotty—and many who need it the most are using it the least.

So suggests a new study published in the Journal of Medical Internet Research.

According to the study’s authors, some of the variation in actual reach can be explained by facility-level differences in MHV adoption, along with differences in patients’ “sociodemographic characteristics”—age, race, income and so on—as sorted by clinical condition.

Led by Stephanie Leah Shimada, PhD, of Boston University and the University of Massachusetts, the authors found that, in this early-adoption phase, “opportunities are being missed for those with specific medical conditions that require intensive treatment and self-management, which could be greatly supported by functions of a tethered personal health record.”

The study looked at a cross section of more than 6 million veterans who had at least one inpatient admission or two outpatient visits between April 2010 and March 2012. Nearly 19% of the sample registered to use the portal. The researchers analyzed these vets’ post-registration use of My HealtheVet to refill prescriptions (11.06%) and communicate with clinicians (1.91%).

Patients with HIV, hyperlipidemia and spinal cord injury had the highest predicted probabilities of adoption, while those with schizophrenia, alcohol or drug abuse and stroke had the lowest. That played out in practice, as, for example, only 8.09% of patients with schizophrenia used the portal to refill a prescription and just 1.11% used it to message a clinician. By contrast, 18.84% and 17.76% of patients with spinal cord injury and HIV, respectively, used the portal to fill prescriptions. Patients with PTSD were among the most active users of the portal.

A little more than 6% were women, 61.45% were Caucasian and 26.31% resided in rural areas. The mean age was 63.3 years.

The authors concluded that, although satisfaction levels were high with an earlier pilot version of My HealtheVet—and although portal transactions have appeared to improve patient-provider communication and patient engagement in care—quite a bit more research needs to be done in order to gauge the clinical value of personal health records and patient portals.

The goal, they stated, must be to find out if such patient access to information proves supportive of high-quality care that is continuous, coordinated, patient-centered, efficient and safe.

“By first developing interventions for patient populations most ready to adopt them while providing training and outreach to those groups lagging in adoption,” they write, “we can move this research agenda forward more rapidly and effectively.”

Many healthcare observers consider widespread adoption of patient portals across the U.S. a matter of when rather than if, and a recent Harris poll would seem to buttress the expectation. The survey, conducted on behalf of Xerox, found a strong majority of Americans not currently using online patient portals but largely willing if only their doctors would make records available online and explain how to gain access.

To read “Personal Health Record Reach in the Veterans Health Administration: A Cross-Sectional Analysis,” click here.