As HHS Secretary Michael Leavitt begins packing his bags making way for incoming Sec. Daschle, he is leaving a number of legacies behind such as a very checkered success record with the NHIN (RHIOs continue to rise and fall with grant funding sources) still lacking traction, a Medicare system still rife with fraud and abuse and the adoption of EMR among small physician practices still abysmally low at some ~4 percent.  I won’t even begin to talk about the FDA and lack of enforcement.

But there have been some successes as well for which he deserves strong praise.  Certainly his outreach efforts via his Blog and similar activities are commendable and I hope that Daschle continues this tradition.  Sec. Leavitt also oversaw the push for eRx, which despite a couple of bumps in the road, (e.g., DEA’s reluctance to allow eRx for certain meds) eRx may portend broader HIT adoption by providing a clear example of the efficiency that such tools can bring to this sector.  The Secretary has also been an extremely strong proponent of interoperablity and the standards that support it.  One can gripe (I do at times) about how some standards seem to be more of an academic exercise, than something that is relevant in the field, particularly among smaller practices and hospitals, but if the overarching goal is to promote the secure sharing of medical records, than it is a step in the right direction.

I also had the opportunity to interact directly with Sec. Leavitt in late July, briefing him and AHIC on trends in the PHR market.  At that meeting I was extremely impressed by how seriously Sec. Leavitt took the subject, studiously taking notes throughout my presentation and asking some very insightful questions afterwards.

What may end up being Sec. Leavitt’s greatest legacy is the Partian Shot he made yesterday when ONCHIT announced the release of a Privacy and Security Framework for e-Record Exchange.  Bob Coffield, a healthcare lawyer based in W.Virginia has written an abstract on the framework.  Like Bob, I’ll be reading the framework over the holidays as there is a lot here to digest.

With the help of others, we’ll take a close look at the entire document, paying special attention to the implications of the proposed framework on the nascent PHR market and the platform plays from Dossia, Google and Microsoft.  It will also be instrutive to see how the ONCHIT framework compares with previous work by the Markle Foundation and lastly, how is does this framework compare and coincide with current proposed PHR certification requirements that CCHIT is currently developing?  Stay-tuned.