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Evaluation and Selection of Open-Source EMR Software Packages Based on Integrated AHP and TOPSIS ⇑ A.A

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Evaluation and Selection of Open-Source EMR Software Packages Based on Integrated AHP and TOPSIS ⇑ A.A Journal of Biomedical Informatics 53 (2015) 390–404 Contents lists available at ScienceDirect Journal of Biomedical Informatics journal homepage: www.elsevier.com/locate/yjbin Methodological Review Evaluation and selection of open-source EMR software packages based on integrated AHP and TOPSIS ⇑ A.A. Zaidan b, , B.B. Zaidan a, Ahmed Al-Haiqi a, M.L.M. Kiah a, Muzammil Hussain a, Mohamed Abdulnabi a a Department of Computer System & Technology, Faculty of Computer Science & IT, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia b Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia article info abstract Article history: Evaluating and selecting software packages that meet the requirements of an organization are difficult Received 24 October 2013 aspects of software engineering process. Selecting the wrong open-source EMR software package can be Accepted 26 November 2014 costly and may adversely affect business processes and functioning of the organization. This study aims Available online 4 December 2014 to evaluate and select open-source EMR software packages based on multi-criteria decision-making. A hands-on study was performed and a set of open-source EMR software packages were implemented locally Keywords: on separate virtual machines to examine the systems more closely. Several measures as evaluation basis Open-source EMR software were specified, and the systems were selected based a set of metric outcomes using Integrated Analytic Multi-criteria decision-making Hierarchy Process (AHP) and TOPSIS. The experimental results showed that GNUmed and OpenEMR soft- AHP TOPSIS ware can provide better basis on ranking score records than other open-source EMR software packages. Ó 2014 Elsevier Inc. All rights reserved. 1. Introduction characterized by multiple (usually conflicting) attributes [3]. MCDM aims to help decision makers select the best alternative, Open-source software (OSS) packages in health informatics sort out potential alternatives among the available options, and online are increasing and gaining greater prominence. This reper- rank the alternatives in decreasing order of their performance toire of open source options benefits future planners interested [4,5]. The evaluation and selection processes involve simultaneous in adopting a system by selecting an existing application. Software consideration of multiple attributes to rank the available alterna- firms have been producing a variety of OSS that can be customized tives and select the best one. Therefore, this process can be consid- to meet the specific needs of an organization. The selecting inap- ered an MCDM problem. propriate OSS adversely affects business processes and organiza- As much as there are variety in healthcare subfields and activi- tional functions. The task of selecting OSS packages has become ties, there are different types of applications. This could be noted in more complex because of (i) difficulties in accessing the applicabil- the projects categories listed in open source healthcare repositories ity of the software for business needs given that a large number of online, Medical Free/Libre and Open Source Software list [17,18]. software packages are available in the market; (ii) incompatibili- An example of application classification in the literature is given ties between various hardware and software systems; (iii) lack of in [19], where the author’s defined 15 functional classes specific technical knowledge and experience of decision makers; and (iv) to the medical domain based on the predominant functionality of ongoing improvements in information technology [1,5]. Evaluators the projects. Some of these classes are Clinical Information Sys- tasked to select an OSS is often under schedule pressure and may tem/Electronic Medical Records System, Messaging, Continuing not have the time or experience to plan the selection process in Medical Education, Data Acquisition, Decision Support, Imaging, detail. Therefore, evaluators may not use the most appropriate Issue Tracking, Laboratory Information System and Telemedicine. method for OSS selection [2]. The process of determining an OSS In this paper, we consider only the first (and the dominant applica- package that meets specific needs of an organization is compli- tion type): open source electronic health record/electronic medical cated and time consuming. Such difficulty has led researchers to record (HEREHR/EMR) software packages. The focus of this study is investigate better means of evaluating and selecting software to evaluate and select open-source EMR software packages based packages. Multi-criteria decision-making (MCDM) problem means MCDM using integrated AHP–TOPSIS in group contents from the making preference decisions over the available alternatives available options of open-source EMR software. The remaining sec- tions of this paper are organized as follows: Section 2 covers the related research and objectives of the present study. Section 3 ⇑ Corresponding author. describes the decision-making methodology for selecting http://dx.doi.org/10.1016/j.jbi.2014.11.012 1532-0464/Ó 2014 Elsevier Inc. All rights reserved. A.A. Zaidan et al. / Journal of Biomedical Informatics 53 (2015) 390–404 391 open-source EMR software packages. Section 4 presents the evalu- In [10], a method called EFFORT (Evaluation Framework for ation and discussion of the results. Sections 5 and 6 discuss the Free/Open-souRce projecTs) was used to evaluate OSS, and an eval- limitations and contributions of this research, respectively. Section uation procedure for the multiple attribute so OSS was defined. 7 presents the conclusion. However, the weights of the attribute were assigned arbitrarily. A high number of criteria make it difficult to assign weight. In [8], an integrated AHP–TOPSIS model for software selection 2. Literature review was proposed and a multi-criteria decision-making evaluation was defined. The model used AHP and TOPSIS. This framework is The currently available open-source EMR software applications appropriate for evaluating multi-attribute OSS, and explains the have not been adequately analyzed and compared to guide poten- methodology and evaluation criteria for software selection. tial implementers. Commonly used decision-making strategies can Other observations based on review of the literature [5] are pre- be compared with those applied to available open-source software sented. First, little work has been performed on developing deci- applications. Several frame works and techniques, each with its sion-making frameworks comprising a methodology, criteria, and own benefits and drawbacks, have been proposed for the deci- technique for selecting software packages. Second, a system/tool sion-making process. with inbuilt knowledge of software evaluation criteria and evalua- A fuzzy-based decision-making technique was proposed in [1], tion technique is required to assist decision makers in software with a fuzzy algorithm was used to describe the appropriate soft- selection and produce consistent and transparent selection results ware selection. The evaluation criteria, methodology for the selec- efficiently. Third, software packages can be evaluated using other tion of OSS, and evaluation of multiple OSS attributes were common criteria related to the quality, cost and benefits of soft- explained. In [11], a fuzzy AHP–TOPSIS two-stage method for soft- ware, as well as the vendor, hardware, and software requirements, ware selection was presented. The method defines a two-step soft- opinion of different stakeholders, and output characteristics of the ware selection, which are fuzzy AHP and fuzzy TOPSIS. The authors software package. Such evaluation option can be utilized although described the evaluation criteria for OSS and defined the method- the functional criteria for software selection are different for differ- ology to acquire the appropriate software according to require- ent software packages. ments. However, fuzzy appropriateness index and ranking values Table 1 summarizes the literature reviewed and data collected for all alternatives are difficult to calculate. that consists of the OSS evaluation, selection methodology and cri- In [7], the AHP approach for software selection was utilized, a teria, different tools used, multi-criteria selection, and a framework problem was decomposed into six steps, and the software was prioritizing OSS. Only the integrated AHP–TOPSIS model consid- selected. The proposed framework defines the criteria and method- ered all the aspects above, thereby helping decision makers under- ology for OSS selection. However, ranking the alternatives depends stand and decompose the problem into a decision-making on the alternatives considered for evaluation; thus, adding or hierarchy. The model is a flexible and powerful tool for handling deleting alternatives can change the final rank (rank reversal both qualitative and quantitative multi-criteria problems. The pro- problem). cedures are applicable to individual and group decision-making. In [9], a hybrid knowledge based system (HKBS) approach was proposed, and compared with AHP and Weighted Sum Model (WSM) methods. This framework elaborated on the evaluation cri- 3. Methodology teria for OSS and the methodology for OSS selection, and priori- tized OSS according to different requirements and evaluation of 3.1. Conceptual framework its multiple attributes. Resulting score of AHP and WSM indicates relative ranking of the alternatives
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