The Office of the National Coordinator for Health IT could include in the requirements for the next stage of meaningful use some functions that would build toward the comprehensive information exchange system that a presidential commission recommended last year.

These functions could include a patient's ability to download information to a personal health record (PHR), simple search by providers and sharing immunization data, according to an advisory panel that is examining the report of the President's Council of Advisors on Science and Technology (PCAST).

Meaningful use in 2013 could promote the use of patient portals, which give individuals access to their electronic health records. Patients could then send or "push" their information or specific data elements to their PHR, which they control, said William Stead, co-chair of the Health IT Policy Committee's PCAST work group.

In another example, patient clinical summaries could be used to incrementally put into practice query and response functionality, such as in emergency departments.

A patient supplies the name of a treating provider but doesn't have the phone number or address. The emergency department physician tracks down the provider through an entity level provider directory and electronically requests the patient's clinical summary, which is in the Continuity of Care Record (CCR) or Clinical Document Architecture (CDA) standard format and contain tagged data elements.

The method of transporting the information or exchange language may be the Direct Project, a version of secure email. Over time, more complex functions will be included in exchange, Stead said.

Providers in a third use case could share childhood immunization data directly with public health agencies or send the data through health information exchanges.

These three examples offer "progressive levels of exchange and technical components that can be used once they are tested," Stead said at a March 17 meeting of the panel. He is also associate vice chancellor for health affairs and chief strategy and information officer at Vanderbilt University Medical Center.

It is not feasible to include a complete "end-to-end" deployment of the technical tools and standards that would carry out the PCAST vision for an exchange architecture in stage two of meaningful use, said Paul Egerman, work group chair and software entrepreneur.

"There is not enough time to prepare detailed regulations and testing criteria," he said, adding that, "we should create an inventory of the building blocks for PCAST."

Dr. Doug Fridsma, director of standards and interoperability at ONC, suggested giving direction for building blocks that would provide value for the states, such as provider directories. "There are some things that are common to all of these use cases and probably for exchange," he said.

The panel is analyzing the effect of the PCAST report published in December on ONC programs, and how ONC can incorporate its far-reaching proposals.

The PCAST report called for a universal exchange language, which is similar to extensible markup language (XML), and other standards to enable healthcare providers to share health information more reliably and effectively in order to modernize and coordinate patient care.

It also proposed that health data be separated into the smallest individual pieces that make sense to exchange. These data elements would be accompanied by metadata tags, or use minimal standards that describe the data and the patient's preferences for its uses and protections. Providers would be able to query for patient information wherever it lives through data element access services (DEAS).