ESSENTIAL COMPETENCIES:

HEALTH DATA ANALYTICS

COMPETENCIES FOR THE HEALTHCARE QUALITY PROFESSION

 Important Notice
National Association for Healthcare Quality 2015. All rights reserved.

No part of this publication may be reproduced or distributed in any form or by any means, electronic or mechanical,
including photocopying, recording, scanning, any information storage and retrieval system, or otherwise, without
the prior written permission of the National Association for Healthcare Quality. For permission or questions about
permissible usage, contact the National Association for Healthcare Quality at info@nahq.org or by mail at National
Association for Healthcare Quality, 8735 W. Higgins Road, Suite 300, Chicago, IL 60631.

Printed in the United States of America

First Edition

2 Q Essentials: Competencies for the Healthcare Quality Profession

Acknowledgments

Project Sponsors
Lenard (Len) L. Parisi, MA RN CPHQ FNAHQ, President, National Association for Healthcare Quality (NAHQ); Vice
President Quality Management/Performance Improvement, Metropolitan Jewish Health System (MJHS)
Stephanie Mercado, CAE, Executive Director, National Association for Healthcare Quality (NAHQ)

Project Team Leadership

Carole Guinane, MBA RN, VP System Orthopaedics, Sentara Healthcare
Dale Harvey, MS RN, Patient Safety Fellow, Director, Performance Improvement, Virginia Commonwealth University Health
System
Tony Heath, PhD CPHQ, Lean and Six Sigma Black Belt, Optum Health
Linda Kloss, MA RHIA, Principal, Kloss Strategic Advisors; Project Consultant
Karen Schrimmer, MA CPHQ, Senior Project Manager, National Association for Healthcare Quality (NAHQ)

Work Group Coleaders

Jason E. Gillikin, CPHQ, Manager of Clinical Analytics, Priority Health, Grand Rapids, MI
Tricia Elliott, MBA CPHQ, Executive Director, Quality and Decision Suppor t, Northwest Community Hospital, Arlington
Heights, IL

Work Group Members

Robert Bunting, PhD CPHQ, Health Information Manager, Anthem, Midland, GA
Kay Chang, CPHQ, Corporate Quality Data Manager, Atlantic Healthsystem, Basking Ridge, NJ
Donald Chock, MHA MA BS, Director of Performance Assessment and Decision Support Services, Kaiser Permanente,
Honolulu, HI
Filiz Costantini, RCIS RRT CPC-A, Clinical Quality Consultant, American College of Cardiology, Rockville, MD
Glynn Fraker, MEd RN CPHQ, Corporate QI Director, Devereux Foundation, Villanova, PA
Elisa Horbatuk, MA, Director, Decision Support, Stony Brook University Hospital, Stony Brook, NY
Stephen Horner, MBA BSN RN, Vice President, Clinical Analytics, HCA, Inc., Nashville, TN
Jodi Johnson, MSN RN CPHQ, Deputy, Quality Management Officer, VA Hospital, Saint Petersburg, FL
Elizabeth Karoly, MBA CPHQ, Manager, Quality Department, Lehigh Valley Health Network, Whitehall, PA
Mary Lewis, RN CPHQ, Corporate Senior Clinical Analyst, Alexian Brothers Health System, Arlington Heights, IL
Kimberly Marshall, BSN BA RN CPHQ, Quality Improvement Specialist, University of Colorado Hospital, Aurora, CO
Tara Payne, MA, Director, Biomedical Analytics Center, Ohio State University, Columbus, OH
Robert Rosati, PhD, Vice President of Quality and Research, VNA Health Group, Red Bank, NJ
Lawrence Wong, MA CPHQ, Catholic Health Services, Pembroke Pines, FL

Essential Competencies: Health Data Analytics 3

Introduction
Healthcare quality professionals (HQPs) aim to ensure that the entire healthcare system is optimized to improve outcomes. As
healthcare rapidly transforms, so do the competencies required to keep HQPs relevant and in a position to lead the transfor-
mation. Today, HQPs understand the dynamics and drivers of change in healthcare.
To ensure that HQPs are well prepared to serve and lead in this evolving environment, NAHQ is defining the essential
HQP competencies in six areas: health data analytics; population health and care transitions; regulatory and accreditation;
patient safety; quality review and accountability; and performance and process improvement. These are the Q Essentials,
NAHQs Essential Competencies for the Healthcare Quality Profession (Figure 1).
The six competency areas of the Q Essentials define the expanding and emerging HQP roles of today and tomorrow. The
Q Essentials build on the industry-recognized foundational knowledge of the Certified Professional in Healthcare Quality
(CPHQ) credential, established in 1983.

Figure 1. Healthcare Quality Competencies Framework

PERFORMANCE
QUALITY REVIEW & & PROCESS
ACCOUNTABILITY IMPROVEMENT

REGULATORY & POPULATION

ACCREDITATION HEALTH & CARE
TRANSITIONS

PATIENT HEALTH DATA

SAFETY ANALYTICS

4 Q Essentials: Competencies for the Healthcare Quality Profession

Current and Future Professional Development Competency Areas
The six intersecting circles in Figure 1 represent clusters of HQP competence. Each cluster represents a distinct competen-
cy area. However, the areas are depicted as overlapping and interconnected because they share certain knowledge and
skills. NAHQ developed the Healthcare Quality Competencies Framework to support self-learning by HQPs who want to as-
sess and expand their competencies to better meet the changing needs of their employers or to gain skills needed for the new
roles. Recognizing that individual interests and skills vary, NAHQs intent for the framework is for ongoing professional de-
velopment to lead to mastery in one area or across multiple areas over time. The areas apply to all healthcare settings across
the continuum regardless of size or specialty.

Why Health Data Analytics?

Quality practitioners follow an array of conceptual approaches that serve the specific needs of the industries in which they
work. Software engineering, for example, tends to prioritize the use of standard work to minimize the introduction of bugs,
whereas manufacturing employs statistical process capability (SPC) approaches to verify that products fall within clearly de-
fined tolerances. In healthcare, at the level of individual practice settings, the paradigm of quality traditionally started with
nurses and localized clinical improvement events. Its only been in the past decade, with the advent of more robust and re-
liable data sources and greater data sophistication among the larger industry actors, that analytics has grown to become a
primary tool in the HQPs toolkit.
The magnitude and sophistication of growth in quality requirementsincluding value-based purchasing, federal incentive
programs, and payer-specific contractual arrangementsmeans HQPs must understand a variety of technical specifications,
statistical procedures, and data sources. The art of quality improvement emphasizes soft skills and clinical judgment to drive
improvement. It is ceding ground to the science of quality improvement, which relies on precisely measured variables to as-
sess improvements and inform strategy.
In this brave, new, data-driven world, HQPs must understand the basics of how data become information and how vast
spreadsheets of numbers get statistically distilled into subtle signals pointing to improvement opportunities. Every practitioner
needs at least a basic grounding in the core principles of data analytics, and every team of practitioners requires recourse to
specialists in analytics who can drive improvements to the next level of sophistication.
Data analytics, at its core, is an approach to quality that converts data into information that is presented through compel-
ling visualizations and journalist-style narratives so that any audience, at any level, can clearly understand the stakes and the
path as quality leads the way in reducing cost, improving outcomes, and expanding access.

How the Health Data Analytics Competency Area Was Defined

A NAHQ work group of subject matter experts representing the clinical, academic, insurance, and healthcare consulting set-
tings developed the competencies using a 90-day, rapid-cycle, practice-based project methodology.

Essential Competencies: Health Data Analytics 5

Area: Health Data Analytics

Competency Dimensions
1. Data Management
1.1. Acquire data from disparate sources.
1.2. Validate the structural integrity of data sets.
1.3. Store data efficiently.
1.4. Ensure the protection of confidential and sensitive data.
1.5. Understand standard administrative health, clinical, and quality data.
1.6. Prevent business interruption by ensuring continuity based on valid and reliable documentation.
1.7. Develop and maintain databases for small-scale analytic projects that are executed solely by the quality department.
2. Applying Statistical Methods
2.1. Understand statistics concepts and accurately apply statistical methods under minimal supervision.
2.2. Demonstrate ability to select, use, and support the most appropriate dedicated statistical programming environments
and general-purpose scripting languages given specific analytics and reporting requirements.
2.3. Assess the relative fitness of data for specific statistical purposes.
2.4. Understand and apply statistical methods associated with various improvement projects to ensure that methodologi-
cal rigor is maintained.
3. Transforming Data into Information
3.1. Clarify expectations about the scope and purpose of the deliverables requested as part of an analytics work effort.
3.2. Fully understand the lessons of the data in light of relevant clinical and operational subject-matter expertise.
3.3. Summarize complex findings through appropriate methods of data visualization.
3.4. Transform a data-driven work product into a comprehensive narrative structure that tells the whole story of the anal-
ysis to a nontechnical audience.

6 Q Essentials: Competencies for the Healthcare Quality Profession

Assumptions
1. The Competency Framework (Figure 1) describes two higher levels of competency that expand current foundational
healthcare quality knowledge to reflect evolving job requirements. It is assumed that Proficiency Level 1 is an advanced
level of competency, and Proficiency Level 2 is more advanced and specialized as it relates to Level 1.
2. Any HQP working primarily with data should be accomplished in the proficiencies listed under advanced practitioner.
3. Skills at the master practitioner level may be required to a varying degree by the healthcare organization, depending
on the organizations size and scope. For example, a small practice may have limited data sources and not require an
in-house data analytics practitioner. They may, however require skills in assessing the abilities of vendors or consultants
to perform such functions on an ad-hoc basis.
4. Master practitioner competencies include skills that an individual HQP may attain on their own or from a staff or consult-
ing team, with each member possessing some subset of the skills.
5. HQPs can learn the competencies in the framework on the job, by attending courses and workshops, or by pursuing
advanced degrees. This framework is not intended to suggest a specific academic pathway.
6. Professionals can enter the field of healthcare quality with a background in healthcare or another industry. Proficiencies
can be gained bidirectionally. For example, one can earn the CPHQ credential (foundational) and then gain specific ex-
pertise in one of the six competency areas. Alternatively, one can enter healthcare quality with expertise in one or more
of the competency areas and learn about the broad base of healthcare quality practice on the job and as demonstrated
by earning the CPHQ certification.

Essential Competencies: Health Data Analytics 7

Area: Health Data Analytics
Dimension 1: Data Management
Description: Acquire, validate, store, secure, and understand data, thus transforming data into valuable, actionable
information.
Proficiency Levels and Descriptors
Competency
(observable behaviors)
1.1. Acquire data from
disparate sources.
1.2. Validate the structural
integrity of manual and
electronic data sets.
1.3. Store data efficiently.
1.4. Ensure the protection of
confidential and sensitive data.
8 Q Essentials: Competencies for the Healthcare Quality Profession
Proficiency 1:
Advanced Practitioner
1.1.1a. Merge varying datasets into a common
definitional structure while ensuring data
accuracy, completeness, and timely availability.
1.1.1b. Understand and interpret current
and proposed or draft measure definitions,
specifications, and collection methodologies
of clinical and administrative data from
different sources, including data for reporting
to governments or to various accreditation or
oversight organizations.
1.2.1a. Clean, transform, validate, or model
data to support accurate decision making.
1.2.1b. Ensure data sets are collected by trained
data abstractors with high inter-rater reliability.
1.2.1c. Compare data from different systems
and use automated data validation methods,
such as checking for outliers, to reduce the risk
of translational error.
1.3.1a. Maintain data architectures, definitions,
dictionaries, and models for analytic databases.
1.4.1a. Apply provisions of the Health Insurance
Portability and Accountability Act (HIPAA) of
1996 and the Health Information Technology
for Economic and Clinical Health (HITECH)
revisions as they relate to privacy and security of
protected health information.
1.4.1b. Describe methods and tools for data de-
identification, file encryption, e-mail security,
and protection of external data sources such as
personal health monitors.
1.4.1c. Understand, interpret, and follow
employers data-security policies and describe
methods and tools used to meet policy
requirements.
Proficiency 2:
Master Practitioner
1.1.2a. Analyze technical data feed
specifications (platforms, attributes, API/EDI
standards, etc.) and build files necessary to
support that specification.
1.1.2b. Develop efficient structure and process
to standardize data definitions and data sources
while ensuring data quality.
1.2.2a. Design evaluation methodology to
determine completeness and accuracy of data,
and develop processes to maximize inter-rater
reliability.
1.2.2b. Verify that calculated values are based
on valid formulas.
1.2.2c. Develop feedback loops to improve the
capture of data for detected error patterns.
1.3.2a. Develop data architectures, definitions,
dictionaries, and models for analytic databases.
1.3.2b. Demonstrate a solid understanding of
relational database theory, including the normal
forms, joins, unstructured data, null versus
missing data, snowflake versus star schemas,
entity-attribute-value models, and the difference
between tables and views.
1.4.2a. Design methods to administer and
monitor access to confidential and sensitive
quality information.
1.4.2b. Develop policy and practices for
governance of quality-related data and report
libraries to ensure that they are available to
authorized users for appropriate uses.
1.4.2c. Understand when provisions of the
Federal Policy for Protection of Human Subjects
(the Common Rule) apply to research
databases and how to follow the organizations
policies and processes under the Common Rule.
Proficiency Levels and Descriptors
1.5. Understand standard
administrative health, clinical,
and quality data.
1.6. Prevent business
interruption by ensuring
continuity based on valid and
reliable documentation.
1.7. Develop and maintain
databases for small-scale
analytic projects that are
executed solely by the quality
department.
Essential Competencies: Health Data Analytics 9
1.5.1a. List the data elements included in
federal health data reporting forms such as
uniform billing forms and describe classification
systems such as the International Classification
of Diseases (ICD) clinical modifications and
procedure classification systems and Current
Procedural Terminology (CPT). Understand
the use of terminology such as Systematized
Nomenclature of Medicine (SNOMED-CT),
Logical Observations Identifiers (LOINC), and
other designated standards.
1.5.1b. Understand the construct of, and apply
the appropriate tools for, grouping coded
data using MS-DRGs and other groupers and
severity-adjustment tools.
1.6.1a. Understand the documentation needed
to ensure appropriate change control and
generate detailed documentation to ensure
clarity and reproducibility (e.g., data sources,
time periods of data used, inclusions, exclusions,
and explanatory footnotes) of analytic findings
by a different practitioner.
1.7.1a. Perform basic data extraction,
translation/transformation and loading activities,
including data normalization, standardization,
quality validation and integration.
1.7.1b. Write and run basic SQL queries.
1.7.1c. Manage complex desktop databases or
other locally controlled relational databases.
1.5.2a. Explain the relationships among
demographic, claims, and clinical data, and
develop new measures or data structures to
leverage the relative strengths of each consistent
with robust data-governance principles.
1.5.2b. Adopt and use data-content standards
as approved by standards development
organizations such as HL7/ASTM and externally
approved consensus standards to optimize
accurate interpretation of quality-related data.
1.6.2a. Develop advanced analysis and
programming techniques or policies to improve
data quality and reproducibility.
1.7.2a. Write stored procedures, triggers,
database indices, etc., with an emphasis on
data aggregation, and develop analytic data
marts using entity-relationship diagrams and
equivalent tools.
1.7.2b. Coach and train other SQL writers.
1.7.2c. Ensure that complex SQL written by the
information technology (IT) department correctly
executes statistical procedures and follows the
best clinical understanding of the question.
Area: Health Data Analytics
Dimension 2: Applying Statistical Methods
Description: Follow a systematic approach using statistical and machine-learning concepts, algorithms, and models to as-
sess data in support of healthcare improvement and data-driven decision making.
Proficiency Levels and Descriptors
Competency
(observable behaviors)
2.1. Understand statistics concepts
and accurately apply statistical
methods under minimal supervision.
2.2. Demonstrate ability to
select, use, and support the most
appropriate dedicated statistical
programming environments and
general-purpose scripting languages
given specific analytics and reporting
requirements.
2.3 Assess the relative fitness of data
for specific statistical purposes.
2.4. Understand and apply statistical
methods associated with various
improvement projects to ensure that
methodological rigor is maintained.
10 Q Essentials: Competencies for the Healthcare Quality Profession
Proficiency 1:
Advanced Practitioner
2.1.1a. Apply analytics approaches such
as decision analysis, risk adjustment,
benchmarking, outcomes analysis, and
patient risk prediction/stratification.
2.1.1b. Understand and apply
probabilistic concepts such as use of
diagnostic tests (e.g., determination of
sensitivity and specificity), calculation of
prevalence, and probability distributions
(e.g., normal, binomial, Poisson).
2.1.1c. Understand and apply hypothesis
testing concepts and methods (e.g., one-
vs. two-sided tests, types of error, power
calculation, sample size estimation, t-tests,
variance analysis).
2.2.1a. Understand current range of tools
well enough to meaningfully engage with
vendor/platform selection.
2.2.1b. Evaluate prospective tools for
their functional capabilities, conformance
to specifications, and their ability to meet
requirements of the analytic environment
such as interfacing to source systems and
local or cloud storage.
2.3.1a. Perform various tests of normality
and validity.
2.3.1b. Impute missing values as
appropriate.
2.3.1c. Recommend specific
improvements to data-collection
procedures.
2.4.1a. Apply appropriate advanced
statistical methods common to defined
quality and process improvement activities
(e.g., process capability, Pareto analysis,
reliability analysis, control charts).
2.4.1b. Apply knowledge to execute
targeted experiments.
Proficiency 2:
Master Practitioner
2.1.2a. Develop regression models, including
linear, multiple, and logistic regression methods.
2.1.2b. Assess Bayesian as well as frequentist
approaches to specific problems.
2.1.2c. Develop specific mathematical models
to isolate trends or reveal improvement
opportunities.
2.1.2d. Understand machine learning and
pattern recognition methods such as artificial
neural networks, decision trees, and support-
vector machines.
2.2.2a. Train others on the use of a specific
analytics platform, including coaching about
the appropriate procedure available within the
platform that will most effectively address a specific
problem.
2.2.2b. Serve, as needed, as analytics platform
administrator or content steward.
2.3.2a. Transform data to meet specific
requirements.
2.3.2b. Propose methods to minimize
confounding variables and limitations of data.
2.4.2a. Provide statistical mentoring and
methodological support to quality and process
improvement work efforts.
2.4.2b. Write protocols for targeted experiments.
Area: Health Data Analytics
Dimension 3: Transforming Data into Information (i.e., Telling the Story)
Description: Transforming data into actionable information by applying various modes of graphical representation and
preparing easy-to-follow narratives to tell an engaging story about opportunities for improvement.
Proficiency Levels and Descriptors
Competency
(observable behaviors)
3.1. Clarify expectations about
the scope and purpose of the
deliverables requested as part of
an analytics work effort.
3.2. Fully understand the lessons
of the data in light of relevant
clinical and operational subject-
matter expertise.
3.3. Summarize complex
findings through appropriate
methods of data visualization.
Essential Competencies: Health Data Analytics 11
Proficiency 1:
Advanced Practitioner
3.1.1a. Develop a clear understanding of
the questions and analytic goals of the target
audience (clinical, business unit) to gain a full
understanding of the project. Assist end user to
clarify questions and goals when needed.
3.1.1b. Obtain consensus among stakeholders
about the specific analytic deliverables required
to successfully answer the core business
questions presented within a given project or
data request.
3.1.1c. Appropriately scope a new analytics
project to define expected deliverables of the
project before work begins.
3.2.1a. Coordinate analytic findings with
relevant subject-matter experts to ensure harmony
of interpretation between the data and evidence-
based or standard-work procedures.
3.2.1b. Develop subject-matter expertise in
the topic, service line, or area of inquiry to
ensure that the data are interpreted according
to an accurate understanding of best-practice
literature and standard work procedures.
3.3.1a. Select specific visualization techniques
based on the most appropriate use (e.g., when
or why to use bar charts, control charts, bullet
charts, run charts).
3.3.1b. Incorporate appropriate elements to
create an informative graph (i.e., descriptive
graph title, succinct axis titles, lack of repetition,
use of appropriate significant digits, lack of
clutter, appropriate use of zero as a baseline on
vertical axes).
3.3.1c. Develop basic dashboards and
scorecards to show internal data as well as
benchmark comparisons (regionally, nationally,
across hospital systems, or hospital to hospital)
that frame PI/QI initiatives, using appropriate
graphical representation of comparative data.
Proficiency 2:
Master Practitioner
3.1.2a. Educate consumers, including
consumers at an executive level, about the most
efficient ways of framing questions or requests
to obtain desired information early in a project
or requests lifecycle.
3.1.2b. Coach project stakeholders to focus
on the broad business or clinical questions, so
the analysts can frame deliverables according
to their expertise, rather than constraining
the analytics process through overly targeted
requests for analytic works products that may
preclude the serendipitous discovery of relevant
wisdom.
3.2.2a. Lead efforts to interpret counterintuitive
data in light of alternative scenarios not
otherwise foreseen by clinical evidence or the
organizations standard work.
3.2.2b. Publish salient findings or procedures in
journals or at conferences to advance the state
of the industry.
3.3.2a. Develop dashboards and scorecards
using advanced visualization techniques
and data capabilities such as embedding
analytics in clinical and business process tools
or designing dashboards tailored to strategic
goals.
3.3.2b. Translate business requirements for
dashboard data into an accurate business-
intelligence layer that correctly reflects nuanced
information, avoids hiding unwelcome
information, and meets customer needs while
maintaining high standards of methodological
integrity.
Proficiency Levels and Descriptors
3.4. Transform a data-driven work
product into a comprehensive
narrative structure that tells the
whole story of the analysis to a
nontechnical audience.
12 Q Essentials: Competencies for the Healthcare Quality Profession
3.4.1a. Manage the dissemination of standing
and special reports so they are directed to the
individuals and groups who should have access
by virtue of their roles and responsibilities.
3.4.1b. Create one-page or shorter executive
summaries.
3.4.1c. Communicate the limitations of the data
to clarify interpretation of findings.
3.4.1d. Prepare appropriate context in the
form of comparative data, historical data,
or information gleaned from best-practice
literature.
3.4.2a. Function as a consultant to senior
leadership about what the data means from a
strategic perspective.
3.4.2b. Follow best-practice journalistic
standards for distilling the essential 5W+H
(Who, What, Where, When, Why, and How)
story structure and use that information as both
an elevator pitch and primary work product for
executives, physicians, managers, regulators,
and others.
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14 Q Essentials: Competencies for the Healthcare Quality Profession

Notes

Essential Competencies: Health Data Analytics 15

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