NI-BC cheat sheet
NI-BC · Keep the key ideas within reach.
Informatics Foundations and Theory
Data-information-knowledge-wisdom (DIKW): data are discrete raw facts; information is data with context and meaning; knowledge is synthesized relationships; wisdom is applied judgment.
Nursing informatics definition (ANA): specialty integrating nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.
Benner's novice-to-expert model: progression through novice, advanced beginner, competent, proficient, expert; informatics competency frameworks map skills to these stages.
Systems theory: a system has inputs, throughputs, outputs, and feedback; open systems exchange with the environment; boundaries define scope.
Change theory (Lewin): unfreezing, moving/changing, refreezing; driving and restraining forces analyzed in force-field analysis.
Diffusion of innovations (Rogers): adoption categories are innovators, early adopters, early majority, late majority, laggards; perceived benefit, compatibility, trialability, and complexity drive adoption.
Sociotechnical model: technology success depends on joint optimization of people, process, technology, organization, and external environment.
Cognitive load and usability theory: working memory is limited; interface design should reduce extraneous load via consistency, chunking, and visible system status.
Information Systems and Technology
EHR vs. EMR: an EMR is a single-organization record; an EHR is designed for cross-organizational sharing of longitudinal health data.
Interoperability levels: foundational (transport), structural (format/syntax), semantic (shared meaning via coded terminology), and organizational (governance/policy).
HL7 v2 uses pipe-delimited messages (ADT, ORM, ORU); FHIR uses RESTful resources (Patient, Observation) with JSON/XML payloads and is the modern exchange standard.
Terminology roles: SNOMED CT for clinical findings and problems; LOINC for lab and observation codes; RxNorm for medications; ICD-10-CM for billing and morbidity; NANDA/NIC/NOC for nursing process.
CPOE with clinical decision support reduces medication errors when alerts are relevant; alert fatigue from excessive or non-specific alerts reduces effectiveness.
BCMA (bar-code medication administration) five rights check: right patient, drug, dose, route, and time verified at the bedside scan.
Downtime planning: define read-only access, paper fallback forms, reconciliation procedure, and recovery validation before returning to live system.
Availability is uptime percentage; redundancy (failover servers, backups) and recovery point/recovery time objectives define resilience, not just hardware speed.
Data Management and Analytics
Data quality dimensions: accuracy, completeness, consistency, timeliness, validity, uniqueness, and precision; usability depends on all of them.
Database structure: relational tables have rows (records) and columns (attributes); a primary key uniquely identifies a row; a foreign key links tables.
Structured Query Language: SELECT fields FROM table WHERE condition GROUP BY field HAVING condition ORDER BY field; joins combine tables on matching keys.
Measure types: nominal (categories), ordinal (ranked), interval (equal spacing, no true zero), ratio (true zero); measure choice determines permissible statistics.
Descriptive statistics: mean (sensitive to outliers), median (robust to outliers), mode (most frequent); standard deviation quantifies spread around the mean.
Sensitivity = true positives / (true positives + false negatives); specificity = true negatives / (true negatives + false positives); predictive value depends on prevalence.
Common quality measures: falls per 1,000 patient days; CAUTI/CLABSI per 1,000 device days; readmission rate = readmissions / discharges.
Data visualization rules: match chart type to data (bar for categories, line for trend over time, scatter for correlation); avoid truncated axes that exaggerate differences.
Clinical Informatics Practice and Workflow
Workflow analysis methods: direct observation, time-motion study, shadowing, and process mapping identify steps, handoffs, and bottlenecks before design.
Usability evaluation: heuristic review, cognitive walkthrough, and think-aloud usability testing with representative users before go-live.
Human factors principles: standardize where possible, make critical information visible, design forcing functions for high-risk steps, and minimize memory burden.
Clinical decision support (CDS) five rights: right information, to the right person, in the right format, through the right channel, at the right time in workflow.
Order-set and documentation-template design should follow clinical logic, avoid duplicate data entry, and use structured fields only where data will be reused.
Implementation lifecycle: needs assessment, design/build, integrated testing, training, go-live, optimization, and post-implementation audit.
Meaningful use / promoting interoperability stages emphasize e-prescribing, health information exchange, patient electronic access, and public health reporting.
Post-go-live monitoring uses usage logs, override rates, and error reports to identify redesign needs rather than assuming training alone solves issues.
Leadership, Policy, and Compliance
HIPAA Privacy Rule governs use and disclosure of protected health information; Security Rule requires administrative, physical, and technical safeguards; minimum necessary standard applies.
HIPAA breach notification: notify affected individuals without unreasonable delay and no later than 60 days after discovery; HHS notification thresholds depend on breach size.
Security triad (CIA): confidentiality (access control, encryption), integrity (audit trails, checksums), availability (redundancy, backups).
Authentication factors: something you know (password), something you have (token/device), something you are (biometrics); multi-factor combines at least two types.
Role-based access control grants permissions by job function; least-privilege principle limits access to what the role requires.
Informatics leadership competencies include strategic planning, project management, change management, budget justification, and interprofessional collaboration.
Informatics governance structures (steering committee, nursing informatics council) prioritize requests, set standards, and align IT investment with organizational strategy.
Project management basics: scope, schedule, and budget form the triple constraint; a RACI matrix assigns responsible, accountable, consulted, and informed roles.
Informatics Foundations and Theory
DIKW hierarchy: data, information, knowledge, wisdom.
Nursing informatics integrates nursing science, computer science, and information science.
Benner stages: novice, advanced beginner, competent, proficient, expert.
Lewin change: unfreezing, moving, refreezing.
Rogers adoption categories: innovators, early adopters, early majority, late majority, laggards.
Sociotechnical model: people, process, technology, organization, environment.
Usability theory: reduce extraneous cognitive load through consistency and chunking.
Systems theory: inputs, throughputs, outputs, feedback.
Information Systems and Technology
EHR supports cross-organization sharing; EMR is single-organization.
Interoperability levels: foundational, structural, semantic, organizational.
HL7 v2: pipe-delimited messages such as ADT and ORU.
FHIR: RESTful resources exchanged as JSON or XML.
SNOMED CT for findings; LOINC for labs; RxNorm for medications; ICD-10-CM for billing.
BCMA verifies right patient, drug, dose, route, time at bedside.
Downtime plan includes read-only access, paper forms, reconciliation, recovery validation.
Availability is uptime percentage; redundancy supports resilience.
Data Management and Analytics
Data quality dimensions: accuracy, completeness, consistency, timeliness, validity, uniqueness, precision.
Primary key uniquely identifies a row; foreign key links tables.
SQL clauses: SELECT, FROM, WHERE, GROUP BY, HAVING, ORDER BY.
Measure types: nominal, ordinal, interval, ratio.
Mean is sensitive to outliers; median is robust.
Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).
Falls per 1,000 patient days; CLABSI per 1,000 device days.
Chart choice: bar for categories, line for trends, scatter for correlation.
Clinical Informatics Practice and Workflow
Workflow analysis: direct observation, time-motion study, process mapping.
Usability methods: heuristic review, cognitive walkthrough, think-aloud testing.
Human factors: standardize, make critical information visible, use forcing functions.
CDS five rights: information, person, format, channel, time.
Order sets follow clinical logic and avoid duplicate data entry.
Lifecycle: assessment, build, testing, training, go-live, optimization, audit.
Promoting interoperability emphasizes e-prescribing, HIE, patient access, public health reporting.
Post-go-live monitoring uses usage logs, override rates, error reports.
Leadership, Policy, and Compliance
HIPAA Privacy Rule governs PHI use and disclosure; Security Rule requires safeguards; minimum necessary applies.
Breach notification to individuals: no later than 60 days after discovery.
CIA triad: confidentiality, integrity, availability.
Authentication factors: knowledge, possession, inherence; MFA combines at least two.
RBAC grants access by job function; least-privilege limits access.
Leadership competencies: strategic planning, project management, change management, budgeting.
Governance: steering committee and nursing informatics council set priorities and standards.
Triple constraint: scope, schedule, budget; RACI assigns roles.
Informatics Foundations and Theory
DIKW: data, information, knowledge, wisdom.
Nursing informatics integrates nursing, computer, and information science.
Benner: novice to expert progression.
Lewin: unfreezing, moving, refreezing.
Rogers: five adopter categories.
Sociotechnical: people, process, technology, organization, environment.
Reduce extraneous cognitive load in design.
Systems theory: inputs, throughputs, outputs, feedback.
Information Systems and Technology
EHR is cross-organizational; EMR is single-organization.
Interoperability: foundational, structural, semantic, organizational.
HL7 v2 uses pipe-delimited messages.
FHIR uses RESTful JSON/XML resources.
SNOMED CT findings; LOINC labs; RxNorm meds; ICD-10-CM billing.
BCMA checks five rights at bedside.
Downtime: read-only access, paper forms, reconciliation.
Availability = uptime percentage.
Data Management and Analytics
Data quality: accuracy, completeness, consistency, timeliness, validity, uniqueness.
Primary key identifies rows; foreign key links tables.
SQL: SELECT, FROM, WHERE, GROUP BY, HAVING, ORDER BY.
Measure types: nominal, ordinal, interval, ratio.
Median is robust to outliers.
Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).
Falls per 1,000 patient days.
Bar for categories, line for trends, scatter for correlation.
Clinical Informatics Practice and Workflow
Workflow: observation, time-motion, process mapping.
Usability: heuristic review, cognitive walkthrough, think-aloud.
Human factors: standardize, visibility, forcing functions.
CDS five rights: information, person, format, channel, time.
Order sets avoid duplicate data entry.
Lifecycle: assessment to optimization.
Promoting interoperability: e-prescribing, HIE, patient access.
Post-go-live: usage logs, override rates, error reports.
Leadership, Policy, and Compliance
HIPAA Privacy and Security Rules; minimum necessary standard.
Breach notice to individuals within 60 days of discovery.
CIA triad: confidentiality, integrity, availability.
MFA combines at least two authentication factor types.
RBAC and least privilege.
Leadership: strategy, projects, change, budget.
Governance: steering committee, informatics council.
Triple constraint: scope, schedule, budget; RACI roles.
Informatics Foundations and Theory
DIKW: data, information, knowledge, wisdom.
Nursing informatics integrates nursing, computer, information science.
Benner: novice to expert.
Lewin: unfreezing, moving, refreezing.
Rogers: innovators to laggards.
Sociotechnical: people, process, technology, organization, environment.
Reduce extraneous cognitive load.
Systems theory: inputs, throughputs, outputs, feedback.
Information Systems and Technology
EHR cross-organizational; EMR single-organization.
Interoperability: foundational, structural, semantic, organizational.
HL7 v2: pipe-delimited messages.
FHIR: RESTful JSON/XML resources.
SNOMED CT findings; LOINC labs; RxNorm meds; ICD-10-CM billing.
BCMA verifies five rights at bedside.
Downtime: read-only, paper forms, reconciliation.
Availability = uptime percentage.
Data Management and Analytics
Data quality: accuracy, completeness, consistency, timeliness, validity.
Primary key identifies rows; foreign key links tables.
SQL: SELECT, FROM, WHERE, GROUP BY, HAVING, ORDER BY.
Measure types: nominal, ordinal, interval, ratio.
Median robust to outliers.
Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).
Falls per 1,000 patient days.
Bar for categories, line for trends, scatter for correlation.
Clinical Informatics Practice and Workflow
Workflow: observation, time-motion, process mapping.
Usability: heuristic review, cognitive walkthrough, think-aloud.
Human factors: standardize, visibility, forcing functions.
CDS five rights: information, person, format, channel, time.
Order sets avoid duplicate data entry.
Lifecycle: assessment to optimization.
Promoting interoperability: e-prescribing, HIE, patient access.
Post-go-live: usage logs, override rates, error reports.
Leadership, Policy, and Compliance
HIPAA Privacy and Security Rules; minimum necessary standard.
Breach notice to individuals within 60 days of discovery.
CIA triad: confidentiality, integrity, availability.
MFA combines at least two authentication factor types.
RBAC and least privilege.
Leadership: strategy, projects, change, budget.
Governance: steering committee, informatics council.
Triple constraint: scope, schedule, budget; RACI roles.
Informatics Foundations and Theory
DIKW: data, information, knowledge, wisdom.
Nursing informatics integrates nursing, computer, information science.
Benner: novice to expert.
Lewin: unfreezing, moving, refreezing.
Rogers: innovators to laggards.
Sociotechnical: people, process, technology, organization, environment.
Reduce extraneous cognitive load.
Systems theory: inputs, throughputs, outputs, feedback.
Information Systems and Technology
EHR cross-organizational; EMR single-organization.
Interoperability: foundational, structural, semantic, organizational.
HL7 v2: pipe-delimited messages.
FHIR: RESTful JSON/XML resources.
SNOMED CT findings; LOINC labs; RxNorm meds; ICD-10-CM billing.
BCMA verifies five rights at bedside.
Downtime: read-only, paper forms, reconciliation.
Availability = uptime percentage.
Data Management and Analytics
Data quality: accuracy, completeness, consistency, timeliness, validity.
Primary key identifies rows; foreign key links tables.
SQL: SELECT, FROM, WHERE, GROUP BY, HAVING, ORDER BY.
Measure types: nominal, ordinal, interval, ratio.
Median robust to outliers.
Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).
Falls per 1,000 patient days.
Bar for categories, line for trends, scatter for correlation.
Clinical Informatics Practice and Workflow
Workflow: observation, time-motion, process mapping.
Usability: heuristic review, cognitive walkthrough, think-aloud.
Human factors: standardize, visibility, forcing functions.
CDS five rights: information, person, format, channel, time.
Order sets avoid duplicate data entry.
Lifecycle: assessment to optimization.
Promoting interoperability: e-prescribing, HIE, patient access.
Post-go-live: usage logs, override rates, error reports.
Leadership, Policy, and Compliance
HIPAA Privacy and Security Rules; minimum necessary standard.
Breach notice to individuals within 60 days of discovery.
CIA triad: confidentiality, integrity, availability.
MFA combines at least two authentication factor types.
RBAC and least privilege.
Leadership: strategy, projects, change, budget.
Governance: steering committee, informatics council.
Triple constraint: scope, schedule, budget; RACI roles.
Informatics Foundations and Theory
DIKW: data, information, knowledge, wisdom.
Nursing informatics integrates nursing, computer, information science.
Benner: novice to expert.
Lewin: unfreezing, moving, refreezing.
Rogers: innovators to laggards.
Sociotechnical: people, process, technology, organization, environment.
Reduce extraneous cognitive load.
Systems theory: inputs, throughputs, outputs, feedback.
Information Systems and Technology
EHR cross-organizational; EMR single-organization.
Interoperability: foundational, structural, semantic, organizational.
HL7 v2: pipe-delimited messages.
FHIR: RESTful JSON/XML resources.
SNOMED CT findings; LOINC labs; RxNorm meds; ICD-10-CM billing.
BCMA verifies five rights at bedside.
Downtime: read-only, paper forms, reconciliation.
Availability = uptime percentage.
Data Management and Analytics
Data quality: accuracy, completeness, consistency, timeliness, validity.
Primary key identifies rows; foreign key links tables.
SQL: SELECT, FROM, WHERE, GROUP BY, HAVING, ORDER BY.
Measure types: nominal, ordinal, interval, ratio.
Median robust to outliers.
Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP).
Falls per 1,000 patient days.
Bar for categories, line for trends, scatter for correlation.
Clinical Informatics Practice and Workflow
Workflow: observation, time-motion, process mapping.
Usability: heuristic review, cognitive walkthrough, think-aloud.
Human factors: standardize, visibility, forcing functions.
CDS five rights: information, person, format, channel, time.
Order sets avoid duplicate data entry.
Lifecycle: assessment to optimization.
Promoting interoperability: e-prescribing, HIE, patient access.
Post-go-live: usage logs, override rates, error reports.
Leadership, Policy, and Compliance
HIPAA Privacy and Security Rules; minimum necessary standard.
Breach notice to individuals within 60 days of discovery.
CIA triad: confidentiality, integrity, availability.
MFA combines at least two authentication factor types.
RBAC and least privilege.
Leadership: strategy, projects, change, budget.
Governance: steering committee, informatics council.
Triple constraint: scope, schedule, budget; RACI roles.