INFORMATION SYSTEM

ENA/MiVitals System

McMet Technologies 12345 Virtual Team Drive

Online City, Texas 54321

P: 800.111.2222

F: 800.333.4444

www.mcmettechnologies.com

Prepared by:

Ashley

Daniel

Desi

Ray

Wendy

Project Paper for Group 2:

Professor Maurer

MGMT 393H

Columbia College

February xx, 20xx

ii

Table of Contents

Introduction…………………………………………………………………………………1-2

Statement of Problem/Business Opportunity…..………………………….…….2-3

The Goals of the New System…………………………………………………….….3-4

Alternatives Considered and Solution Selected…………………………..…….4-7

Details Concerning the Solution……………………………………………………7-11

Implementation…………………………………………………………………………11-14

Cost-Benefits…………………………………………………………………………….14-15

Conclusion……………….……………………………………………………………….15-16

Bibliography………………………….……………………………………………………..17

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Introduction

Overview

McMet Technologies is a virtual company with a mailbox in Online City, Texas. The

company is not afraid to tackle new challenges in a technological manner. The executive

management team--Ashley, Daniel, Desi, Ray and Wendy--designed the company from the

ground up to integrate information, people, and information technology (IT). By utilizing a

management information system (MIS), McMet Technologies seeks to address issues where

technology can replace humans. With an alarming amount of baby boomers retiring soon, the

medical industry is where we decided to direct our financial, human, and technological

resources. Some of the interesting tools utilized by McMet Technologies include various forms

of artificial intelligence (AI) technologies, networks, databases and data warehouses. Our new

product is the ENA/MiVitals System—an all-in-one system that collects patient’s data and

transforms it into useful information.

Mission

McMet Technologies has assembled a diverse group of IT users to solve a spectrum of

challenges concerning Columbia College Hospital’s patient wait times. Our goal is to provide

patient-accelerated medical assistance while minimizing the need for medical staff, which

represents the following areas of the hospital: nurses, physicians, and physician assistants,

administrators, leaders from patient registration, the laboratory and care management.

Throughout this presentation we will discuss the hospital wait time problem, discuss a business

opportunity due to this problem, the goal of the business opportunity, alternatives considered

with a solution, details concerning the solution, how McMet Technologies plan on implementing

the business opportunity, and cost benefits of this innovating technology. We know that the

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management at Columbia College Hospital welcomes the opportunity to continually find ways to

improve, so we are proud to share our problem solving idea, while helping you open the door to

the future of medical facilitation and services.

Statement of Problem and Business Opportunity

Hospital wait times kill people. By re-examining patient flow, implementing new

guidelines, adjusting staffing, and redefining nursing roles, the Columbia College Hospital

management team helps bring significant improvements to the patient experience; however, the

patient wait times remain longer than expected. Hospitals, Clinics, and Doctor’s offices all over

the world are experiencing unfortunate and unnecessary wait times. While the patient

examination, care, and service delays in the medical institutions are due to no fault of the

medical staff, they are often blamed and held accountable for what some consider, neglect. As

similar accusations are conjured up among the sick, dying, and of the family of those who died

while waiting for care, lawsuits against these institutions arise. Listed below are headline news

stories of hospital waiting rooms mishaps due to long wait times.

Examples

A New York City hospital where a Jamaican immigrant died from a blood clot after

waiting nearly 24 hours to be seen has agreed to a legal settlement that will place it under federal

supervision for the next five years. Kings County Hospital (KCHC) in Brooklyn came under

state and federal investigation after 49-year-old Esmin Green died on the hospital's waiting room

floor (Gutierrez).

Man Dies in Hospital Waiting Room

The family of an aboriginal man found dead after spending 34 hours in an emergency

department says they will sue a Winnipeg hospital, medical staff, the regional health authority

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and the Manitoba government. Brian Sinclair, a 45-year-old double amputee with a speech

problem, was found dead in his wheelchair in the Winnipeg Health Sciences Centre's E. R. after

spending 34 hours in the hospital's waiting room (McKiggin).

Death Could Have Been Prevented

An autopsy performed shortly after his death by the province's Chief Medical Examiner

determined Sinclair died of a blood infection. Dr. Thambirajah Balachandra said Sinclair's death

could have been prevented if the blood infection had been treated. Sinclair's family is now

considering a lawsuit against the Hospital and the Health Authority (McKiggin).

As the number of lawsuits increase, so does the cost of medical insurance. This fact has

made medical insurance unaffordable for many which intensify the need for emergency room

services because this is where the uninsured muster for medical care. After a while, there are

more patients waiting for care than the medical staff can handle in a timely manner. Over

staffing medical facilities seems like it would solve the problem, but it doesn’t. Hospitals are

only so big, and at some point, space tends to be limited. The cost of staffing versus the revenue

intake could also play a part in wait times since a lot of emergency room patients are uninsured

and in more cases than not, can’t afford the medical expenses incurred. McMet Technologies

has acknowledged an ongoing and growing problem in the medical field, and we have a solution.

It’s an extension to the electronic health records (EHR) system. We call it electronic nursing

assistant (ENA) or better yet, ENA/MiVitals system!

Goals of the New Systems

Goals of the new system would include a reduction in healthcare costs, employees, and

office space. Furthermore, the new system would expedite patient care, lower patient stress, and

offer a greater level of accuracy with computerized results. Patients would have greater record

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privacy and would be empowered to participate in their own medical care. Healthcare costs will

be lowered because the operation would be able to hire fewer staff. The medical facility itself

could be reduced to fewer square feet resulting in lower costs in insurance, taxes, utilities and

repairs. The middle man would be removed in handling records; therefore, fewer mistakes

would be made resulting in fewer lawsuits helping to drive down medical costs further.

Reduced wait time is a big advantage of this new technology because the patient will be

responsible to do the check-in process without nurse assistance and without the aid of office

staff. A direct correlation has been found between patient frustration and the lack of

involvement and medical knowledge. So, when a patient feels out of control or

unknowledgeable about their medical situation, their stress level is much higher. This new

system would involve the patient in their own medical care making them more empowered and

confident; thus, reducing their stress. The medical facility would be a more patient-centered

facility. In addition, the patient’s record will be handled by fewer people causing higher privacy

of the records. This system will teach the patients while they are entering their information

about the importance of diet and exercise and following the healthcare program the doctor

recommends; therefore, causing them to care more about their health.

These patient-centered goals are intended to make the patient more aware of his/her

health. It is the hope of these goals that people learn more about themselves and their health

risks. When the general public is knowledgeable, they are healthier.

Alternatives Considered and Solution Selected

There are various options to consider when addressing healthcare problems. Two

predominant complaints patients voice with healthcare are excessive amounts of time spent

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waiting for care and the high cost of this limited care. Alternative solutions consist of implant

chips and cloud computing.

Implant Chip

An implant chip is “a technology-enabled microchip implanted into the human body that

stores important information about you … [which also] … may be GPS-enabled to offer a

method of tracking” (Haag and Cummings 271). The stored information would include all of the

patient’s accumulative medical history, their age, race, height, health insurance plan, and other

pertinent information. The implant chip would be implanted in the patient’s finger.

One advantage to an implant chip is that the patient is not required to have any form of

identification on their person or with their family. This would be valuable in case of a traumatic

injury, such as a car wreck resulting in the patient being unconscious or unresponsive. Doctors

would immediately know all the medical history of this patient, what medications they are taking

and allergies. This could save time and lives. This information could include a patient’s wishes

in cases that require life-support services. It would also give emergency contact information.

Currently, patients that are diabetics, susceptible to seizures or allergic reactions may carry cards

or wear bracelets to inform paramedics. This implant would make the old methods obsolete.

There are several concerns about this particular product because of fears pertaining to

governmental interference and potential civil rights violations. Additionally, violations of

privacy are potential concerns with this technology. Conspiracy theorists believe that the United

States government is trying to reduce the right to privacy in American homes, and this device

only feeds that type of thinking. Furthermore, fundamental Christians could view this device as

a biblical sign of the mark of the beast and refuse to get the implant.

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Cloud Computing

The second alternative is cloud computing. Cloud computing is “a technology model in

which any and all resources … are delivered as a set of services via the internet” (Haag and

Cummings 205). Examples include application software, processing power, data storage, backup

facilities, development tools, and etc. The process involves a nurse going to the patient’s home

and recording all of a patient’s medical history and pertinent information. The nurse would then

upload the retrieved information taken via a smart card to the cloud. When the patient arrives for

an appointment they are required to download all of the information into that particular office’s

database. This will allow the medical staff to gain easy access to all medical history.

Advantages include having readily available information, less filing, and office work

which is an economic savings. However, a disadvantage of cloud computing is the smart card

itself coupled with human nature. Having a smart card is similar to the current procedure of a

medical notification card worn around a patient’s neck. If the smart card is lost then all the

records are lost. This would require medical staff to send the nurse or medical staff out to the

patient’s house a second time to record the information on the smart card. Furthermore, if the

patient was in a car crash and the smart card was damaged during impact and was not readable

by a computer then the information contained within it would be useless. Durability and loss

(identity thief) could be a major concern with this product.

Solution Selected

In comes a real solution in the form of our ENA/MiVitals system. Although implants and

cloud computing are viable options, the executive management team at McMet Technologies

believes that their technological approach will allow them to solve the current and future issues

pertaining to the healthcare industry. ENA/MiVitals is an integrated system that employs

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numerous technologies. This all-in-one solution is comprised of artificial intelligence (AI)

components, application software, and many other technologies. A key feature of the system is

its ability to transform data into accurate information for users. The end users (medical staff)

depend on timely, accurate, and up-to-the-minute information to serve a wide variety of clients.

ENA/MiVitals is a perfect solution because it can eliminate human error when collecting data.

While processing will occur at the server level, ENA/MiVitals will be the source of capturing

patient data and adding it to their files. This essential feature supersedes competitive products in

the marketplace. Although the ENA/MiVitals system will be the customer-facing aspect of the

solution, there is a hidden portion out of the patient’s or end-user’s eyesight that supports the

inputs into the system. All hardware (infrastructure) components will be located at a collocation

facility.

Details Concerning the Solution

In an effort to accomplish the goal of this solution, we carefully planned each piece of the

project. A top-down approach was necessary to ensure the infrastructure needs as well as client

needs are met.

SAN

McMet Technologies decided to use Cisco storage equipment in order to maintain a

homogenous environment and increase interoperability. On the top tier, we configured a 40-

drive Storage Area Network (SAN). The SAN will hold all patient medical records and Online

Transaction Processing (OLTP) data. The SAN will employ RAID 10 (Redundant Array of

Inexpensive Disks) for data redundancy. Data will be stripped across 40-hard drives for data

physical view. Each hard drive will be a solid-state; 600-gigabyte is size with 10,000 revolutions

per minute for fast data access. The RAID 10 configuration will provide sophisticated data-

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backup requirement needed to protect patient data integrity. The SAN will push specified data

(i.e., age, sex, height, weight, ethnicity, health insurance type, employment type, and address)

over to the data warehouse.

Data Warehouse

A data warehouse will link to the SAN via fiber channel in order to provide gigabit speed

between data transfer. In addition, the data warehouse will help the hospital’s decision makers

obtain business information (BI). This technology continues to emerge as one of the most cost

effective ways to analyze medical data (Haag and Cummings 82). McMet Technologies, at the

request of the medical center, set up the data warehouse to capture data such as: age, sex, height,

weight, ethnicity, health insurance type, employment type, address, disease, and treatment type.

The data warehouse will manipulate data/information via data-mining tools, query and reporting

tools, and additional multidimensional analysis tools (Haag and Cummings 79). In order to ease

integration across the organization, all business information will be displayed using a BI

dashboard and the following file formats: .csv, .doc, .docx, .txt, .xls, and .xlsx. The use of these

file types will allow the reporting tools to be used across the existing computer operating systems

at the medical center. Therefore, no significant changes will need to be made to the center’s

computer workstations.

Blade Servers

The SAN will connect to the network core, in particular, fiber switches. The Cisco blade

servers will connect to the same fiber switches to allow connectivity between it and the SAN to

form part of the 3-tier infrastructure. This connection design will ensure gigabit transmission

speed. We will deploy Cisco Unified Computing System (UCS) blade server chassis and B-

series Cisco servers to minimize the infrastructure footprint in the Main Distribution Frame

(MDF) room. In addition, this equipment permits flexibility, availability, and scalability −three

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metrics we anticipated during the analysis phase of this project. In the event of a server (i.e.,

blade) failure, the Cisco USC chassis’ flexibility will allow hot swap repairs to blades and or

power supplies (Cisco UCS B-Series Blade Servers). Therefore, the executive team will notice

that a server (i.e., blade) failure will not affect the system availability as it did in the past. The

Cisco UCS chassis is intelligent enough to continue operating while resource addition and or

repairs occur (Cisco UCS B-Series Blade Servers). For instance, we can add additional servers

(i.e., processing power) and the system will auto-adjust to incorporate the additional servers

(Cisco UCS B-Series Blade Servers). Each UCS chassis will connect to a Cisco network switch

via fiber channels to allow gigabit transmission.

ENA/MiVitals System

We outsourced the development of the ENA/MiVitals system, a biometric processing

system. The ENA/MiVitals system is a computerized nurse’s assistant system that will help

streamline patient care. We employed the help of Panasonic Corporation and QRS Diagnostic

Inc.--two medical manufacturers--to help us develop the ENA/MiVitals system. The

ENA/MiVitals system will be a dedicated all-in-one system that will record patient blood

pressure, body temperature, height, weight, heart rate, and pulmonary capacity and transfer the

data to the server.

While the ENA/MiVitals system is in use, the attending nurse/staff can view the patient’s

results of each test via a computer workstation. Once the patient testing concludes, the results

will update the appropriate patient file. In order to verify data integrity, we created a graphical

user interface (GUI) that will display the patient file and changes in real-time. This feature can

help verify the correct patient record if changed. For example, if the system identifies two

patients with the same name and or address (but the file is missing primary key data), the nurse

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can search for unique information (e.g., partial social security number, transposed Medicaid

identification number, etc.,) and attach the results to the file. If staff members identify such a

conflict within the system, they should open an IT service request immediately. In the event a

patient does not have a United States issued Social Security number, the nurse can use other keys

to append a record such as: driver’s license number, passport number, U.S. State Department

passport card number, and or state identification number. The aforementioned identification

numbers are also primary keys across our database but we understand that this data is not always

gathered during a patient’s hospital visit (e.g., emergency).

ENA/MiVitals systems outside of the network (i.e., remote stations, off-site stations,

etc.,) will access internal network via Virtual Private Network (VPN) Tunneling. For security

purposes, each VPN Tunnel will be encrypted. Information traveling into the network will

authenticate via network firewall. On the other hand, once the patient’s file has been updated, it

will be compiled into a printable summary report (e.g., copy of patient file).

In order to provide a single application platform, this solution will use SAP AG

Corporation (SAP) business solutions software. The SAP business solution will provide the

following: (1) Business intelligence, (2) Customer relationship management (CRM) and (3)

Enterprise resource planning (ERP). The data warehouse will use the tools (i.e., query tools)

provided by SAP to help staff identify patient treatment. For instance, business intelligence can

help identify an epidemic (e.g., flu outbreak) and a treatment (e.g., flu vaccination type). The

SAP customer relationship management application will help us “gain insight into our patient

needs and behaviors in order to server them better (Haag and Cummings 42). The SAP

enterprise resource planning (ERP) tool will help the organization identify additional resource

needs such as inoculation levels (e.g., timely order of vaccine) and or material needed for daily

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consumption (e.g., hospital gowns).

Collocation Point

McMet Technologies has set up a mirrored environment at the medical center’s

collocation point. The collocation point will hold the same SAN and data warehouse

configuration that is in MDF room at the medical center. McMet Technologies installed two

firewalls (hardware and software) to (1) protect incoming/outgoing traffic, (2) provide redundant

protection of network authentication, and (3) compliance with the Health Insurance Portability

and Accountability Act (Haag and Cummings 243).

Implementation

Training implementation

McMet Technologies will take a phased approach toward the implementation of this

solution. Prior to solutions’ implementation, however, we will continue to update staff members

with the project status through the project plan, e-mails, memorandums, and or meetings. On the

other hand, McMet Technologies will provide training for the appropriate medical center staff

such as IT, managers, nurses, and additional staff members about the new system. This training

group will be under the direct support of McMet Technologies. In addition, each vendor (Cisco,

Panasonic, QRS Diagnostic, and SAP AG) pledged to keep on-site resources by providing

systems specialist in order to assist with system issues. The training of the hospital staff is a

critical part of the project. Therefore, the first group of people to receive training on the new

information system will be the helpdesk. McMet Technologies developed several training

workshops and computer training (E-learning modules) that will last throughout the

implementation of this solution. The project plan indicates the first training group (IT staff,

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managers, nurses, and additional staff members) will be complete 30 days before solution

implementation.

Equipment implementation

McMet Technologies will use just-in-time (JIT) shipping on the network infrastructure

equipment in order to help prevent damage and or theft of goods. Once McMet is ready to install

this equipment, it will drop ship it to the medical center. Upon receipt, McMet will send cross-

functional teams comprised of network engineers, database administrators, and computer

technicians to assist with the installation of the network infrastructure. Once they complete their

tasks, McMet technologies will use JIT shipping of each ENA/MiVitals stations. We will break

out the installation of the MiVitals systems into four phases. Each phase will affect the

installation of five ENA/MiVitals systems. As each station will be installed and configured and

tested. In testing, we will use the pseudo patient name McMet, and the false Social Security

number 111-11-1111. We have turned this information over to medical center’s information

technology (IT) staff also. On the 31 st day (after initial training is complete) of the project, we

will deploy ENA/MiVitals systems to low-traffic areas. Implementation of the emergency room

and intensive care unit will be subsequent to the low-traffic areas. According to the project plan,

the rollout process (not including training) will take approximately 35-business days to complete.

During this process, we will conduct weekly meetings to address open items and update

stakeholders. It is important we conduct weekly meetings in order to avoid scope creep and

manage end user expectations.

Maintenance implementation

In accordance to the System Development Life Cycle (SDLC), we must monitor and

support this new system (Haag and Cummings 166). We believe the most appropriate form to

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support this system and extend the customers’ satisfaction is through: (1) Helpdesk training for

system support, and (2) weekly review and fix for open/support requests. McMet Technologies

believes if your firm employs its internal helpdesk to support the system, several benefits will be

realized. First, the helpdesk is the first group to support the organization’s information system

systems. In addition, they currently use an SAP CRM system to track issues. They can continue

to use this tool to create service request, record information, and track trends (i.e., root cause) for

this new system too. Second, when emergency support is required, the helpdesk can escalate the

service request to a specialist (tier-2 support) as they currently do with their existing system.

Lastly, all employees will be required to call the medical center’s helpdesk number in order to

receive our (McMet Technologies) technical support. Therefore, the medical support structure

remains the same and its employees have a single point of contact for technical issues.

Next, we will hold weekly “change control” meetings with the firm’s information

technology department in order to discuss open tickets (i.e., unresolved technical issues).

System-wide changes (i.e., patches) if necessary, will occur on Wednesdays at approximately

12:01 AM astern Standard Time. These changes are “system maintenance” changes and should

be addressed as such during change control meetings. During these system maintenance

changes, the solutions database will switch over to the collocation point’s infrastructure.

Therefore, there will be little, if any, interruption of services to staff. The purpose of the system

maintenance is to address a technical(s) issue only after our specialists develop a patch, test it,

and push it over to the medical center.

Finally, McMet Technologies has a 1-year Service Level Agreement (SLA) starting on

March 5 th

, 2011 ending on March 5 th

, 2012 at 12:00 AM Eastern Standard Time. Our Service

Level Agreement discusses in-dept details about the financial agreement, key metrics, and

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benchmarks that we will support (Haag and Cummings, 211). Please note details of these

metrics, benchmarks, and technical specifications are addressed in the Service Level

Specification (SLS) document (Haag and Cummings 211).

Cost Benefit Analysis

Cost estimates

In 2007, author Alan Krueger, estimated that Americans spent 847 million hours waiting

for medical services. If time is money, then there is significant room for improvement. McMet

aims to reduce the time spent waiting for medical services by providing computerized routine

testing of vital statistics and documentation to client files, or electronic health records (EHR).

The goal of a cost-benefit analysis of an EHR system and its assimilation into the

ENA/MiVitals system is to justify the expense and reduction of net profits in the healthcare

organization (Haynes). There are two costs associated with an EHR system. The first group

includes hardware, software, implementation and training. The second involves any loss of

production or efficiency during the implementation period. We encourage the use of a phased

implementation program in order to reduce any loss of production while providing the best

possible training for users.

A single doctor’s office can expect to make the following initial estimated expenditures:

Hardware $6,000 Software $1,500 Implementation $2,000 Support $1,000 Productivity Loss $2,000 -----------

Total $12,500 (Haynes)

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We would expect to update hardware approximately every three years, software and

annual support would be an annual expense, while implementation is part of the initial

investment only. Productivity loss should be mitigated after the first year.

Gains

A significant benefit of an EHR system is the ability to reduce the cost of manpower to

pull and update physical charts. If we assume that in the first year we can save $5 per patient by

using electronic charts and updating those charts automatically and we do this for 500 patients in

the first year, which is a savings of $2500 in year 1. Let us assume that we increase the use of

electronic charts for an additional 100 patients per year. There will be additional savings of

nursing time, doctor’s time and the number of additional patients which can be seen annually due

to the time savings. We will estimate this as 200% of the in flow of “chart pull” savings.

EHR Project

Initial Year 1 Year 2 Year 3 Year 4 Year 5

Inflow $5,000 $6,000 $7,000 $8,000 $9,000

Outflow $12, 500 $2,500 $2,500 $8,500 $2,500 $2,500

Net Cash Flow ($12,500) $2,500 $3,500 $(1,500) $5,500 $6,500

0 1 2 3 4 5

($12,500) $2,500 $3,500 $(1,500) $5,500 $6,500

(Haynes)

As patients records are updated to EHR, there would be compounded additional savings and

work force time, which are difficult to estimate.

Conclusion

The ultimate goal of McMet Technologies ENA/MiVitals system is to provide medical

centers with key patient data quickly and upload that information to electronic medical files.

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This will increase efficiency and accuracy while eliminating the need for staff to manually record

data. ENA/MiVitals will: (1) capture patient test results at the ENA/MiVitals station (a hybrid

between a heart monitor, Spirometry machine, blood pressure machine, scale, and thermometer,

and computer.), (2) record and process this data at the upper levels of the network (data captured

at the MiVitals system is then pushed over to servers, operational databases, and then data

warehouse.), and (3) provide nurse/staff with a summary of a patient’s medical file prior to

doctor’s examination.

Efficiency will be of the utmost importance as nearly 76 million baby boomers retire

within the next decade (Nursing). At the same time, retirees are expected to require three times

the healthcare services. Added to that is the move to national healthcare reform and we can

expect millions of previously uninsured Americans seeking care at doctors offices. The

Association of American Medical Colleges says that by 2025, the nation could be 150,000

doctors short of the number we need (Chapman). We can expect that more primary care will fall

to nurses, nurse practitioners and physician assistants. The aim of McMet Technologies is to

provide nursing staff with the ability to see patients efficiently while reducing the amount of time

they spend on indirect patient care such as updating paper records. McMet Technologies and its

flagship ENA/MiVitals system is the best choice for leading edge technology for your office.

See more patients, update records quickly and let us help you to keep America healthy.

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Works Cited

Chapman, Steve. “Nursing Our Way Out of a Doctor Shortage.” Reason.com. 19 April 2010.

Web. 22 Feb. 2011 <.http://reason.com/archives/2010/04/19/nursing-our-way-out-of-a-

docto>

“Cisco UCS B-Series Blade Servers.” Cisco.com. (n.d.). Web. 20 Feb. 2011.

<http://www.cisco.com/en/US/products/ps10280/index.html>

Gutierrez, David. “Patient dies in waiting room at NYC hospital after waiting 24 hours with a

blood clot.” Naturalnews.com. 15 June 2010. Web. 21 Feb. 2011

<http://www.naturalnews.com/028993_waiting_room_hospital.html#ixzz1EtmVO1oD>

Haag, Stephen, and Maeve Cummings. Management Information Systems: For the Information

Age. 8 th

ed. McGraw-Hill/Irwin, 2010. Print.

Haynes, Dr. Beth. “Paperwork vs. Patient Care.” Blackribbonproject.blogspot.com. 20 April

2010. Web. 22 Feb. 2011<http://blackribbonproject.blogspot.com/2010/04/paperwork-vs-

patient-care.html>

McKiggin, John. “Medical Malpractice Claim Filed After Hospital Waiting Room Death.”

Halifaxmedicalmalpracticelawyerblog.com. 17 Sept. 2010. Web. 21 February 2011<

http://www.halifaxmedicalmalpracticelawyerblog.com/2010/09/medical_malpractice_clai

m_file.html%3E>

“Nursing Shortage Crisis! Over 76 Million Baby Boomers.” Nursing.com. 25 Jan. 2010. Web.

22 Feb. 2011<http://nursingcom.com/tag/crisis>

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