Rationale A growing number of health systems are developing or using registries and EHRs that permit large-scale queries to support population health management strategies to identify undiagnosed or undertreated hypertension. Such innovations are implemented as ongoing quality improvement initiatives in clinical practice. To reduce undiagnosed hypertension and improve hypertension management, a multipronged approach may include 1) application of hypertension screening algorithms to EHR databases to identify at-risk patients, 2) contacting at-risk patients to schedule BP measurements, 3) monthly written feedback to clinicians about at-risk patients who have yet to complete a BP measurement, and 4) electronic prompts for BP measurements whenever at-risk patients visit the clinic.55,57 Since passage of the Hitech Act, the use of EHRs and registries in clinical practice has become nearly ubiquitous. The purpose of this SM is to provide guidance to the CDU to aid in the identification of patients with elevated BP or stage 1 or stage 2 HBP through the EHR and/or registry. Previous studies have demonstrated that many patients with elevated BP or stage 1 or stage 2 HBP are undiagnosed with conventional administrative data sets (ICD-10). Use of free-text data searches or structured data searches can facilitate the identification of appropriate patients. In particular, we recommend the use of NQF s denominator exceptions for medical, patient, and system exceptions to improve the accuracy of the data. The evaluation of structured data will greatly facilitate the accuracy of this hypertension performance measure. The intention of this measure is to promote the accurate collection and analysis of BP and demographics through the EHR by using standards-based tools. Currently, most EHRs and registries do not have a specific mapping of sufficient elements to allow the accurate recording and attribution of BPs. 