It has been nearly a year since the start of stage 1 of the government incentive program for meaningful use of EHRs. If you logged three months of meaningful use earlier this year, you should have already received a check for $18,000. As physicians begin to reap some of the benefits of integrating EHRs into practice, questions remain as to the specific nature of qualification and how strict CMS will be in maintaining its standards. Ahead, I will share details of my own experience as an EHR user and reveal tips on how to comply with the CMS guidelines. Hopefully, my comments will help those who are getting ready either to buy an EHR, to begin the period of Meaningful Use, or for attestation.

Core Measures

In September, I received a check from CMS for successfully completing Stage 1 of Meaningful Use. More important than my receiving the money, are the details of what I attested to. The first that I would like to address is the core measure to which dermatologists are arguably most vulnerable: Measure #8 "Record Vital Signs". This measure tends to box us in, as you basically have two choices: either take Height, Weight, and Blood Pressure on at least 50 percent of your patients in the reporting period (since if you measure one, you must measure all three), or take no vital signs on any patients during the period, and claim an exclusion, as not being relevant to your scope of practice. I claimed an exclusion for this measure.

Another core measure—#10 "Clinical Quality Measures (CQMs)"—is also challenging for many dermatologists. Although it states that you cannot claim an exclusion for the measure, you can claim exclusions for each individual CQM, which include the three core, three alternate, and 38 additional measures. This adds up to a total of 44 clinical quality measures. I claimed exclusions for all 44 measures. In other words, I had a denominator of zero for each of the 44 measures.

As for the Menu measures (for which you need to do five out of 10), you are supposed to choose one of the last two measures ("public health") as one of the five to which you attest. As my practice does not collect syndromic information on our patients and did not perform any immunizations during the reporting period, I claimed an exclusion for both and only had to attest to four other Menu measures.


Dermatologists have been rightfully wary for some time about completing the necessary core measures to meet the standard for Meaningful Use. Given these concerns, I intended to test the system to find the lowest common denominator that CMS would accept and what it would not. That I was awarded a check for Stage 1 completion despite claiming exclusions for many of the measures that aren't relevant to dermatology indicates that CMS is fairly lenient in terms of meeting the necessary criteria. CMS apparently is oriented more strongly towards following the format provided by the core measures. You do not necessarily need to perform them all, so long as you follow the template and claim exclusions where they apply.

However, whether the same standard will hold true for the remaining stages of Meaningful Use is difficult to predict. It is very possible that CMS may become more stringent as it progresses into the later stages. (Efforts are afoot to prolong Stage 1, so at this time it is still uncertain when Stage 2 will begin.) There still appears to be some hesitation on the part of dermatologists about embracing the later stages of implementation. Based on what is known now about Stage 1, however, we can appreciate that CMS and the government have been accommodating to this point and lowered the bar significantly, perhaps to attract more users.

The most important point of interest to clinicians regarding Stage 1 is that you don't have to change the way you practice in order to qualify for incentives. Meeting the guidelines should not be a hindrance, whether or not you choose to pursue incentive dollars for the later stages. As clinicians continue to navigate the muddy waters of Meaningful Use, the results of Stage 1 thus far have been encouraging and hopefully point to a brighter future of EHR use in dermatology.

Watch Dr. Kaufmann discuss the status of EHRs in Dermatology at records/

Mark Kaufmann, MD is co-chair of the Dermatology work-group for CCHIT. He is also on the Medical Advisory Board of Modernizing Medicine.