Is there an exemption from the federal EHR mandate?

A: Yes, it does, but be aware that nothing is final. The American Recovery and Reinvestment Act, the legislation that created the incentives and penalties for EHR use, does contain a clause about a hardship exception, but it's not official until the Department of Health and Human Services defines what "meaningful use" of electronic records is. That final definition could include the hardship exemption that you're referencing, according to the Centers for Medicare and Medicaid Services. As it's written now, the hardship exemption contains few details. It does, however, specify that exemptions will be given "on a case-by-case basis" by HHS, and that exemptions will last a maximum of five years. HHS is expected to provide more detail on this when it issues its definition of "meaningful use" by the end of 2009.