In Traditional Korean Medicine, diagnosis and treatment are made individually and dialectically with sensitivity according to the physiological and pathological characteristics of the individual [1,16]. This feature can be tailored to the pathology of the patient and has the advantage of excellent therapeutic effects . In this study, more than 90% of Traditional Korean Medicine doctors used prescriptions in the form of adjusting drugs according to the patient’s condition. It is common practice that the medicines are combined according to the theories of ‘Kun-Shin-Choa-Sa’ and that treatments are administered dialectically with sensitization, meaning that the pharmacy and prescription structure is of great importance in the overall treatment. Therefore, the study result showing that the Traditional Korean Medicine doctors desired prescription support functions such as information on basic medicine and interaction, prescription search, and analysis of prescription structure, can be explained in the same context.
The Decision support system (DSS) is divided into clinical DSS and external DSS. Clinical DSS includes clinical guidelines such as Drug Utilization Review (DUR), Drug Preparation, Critical Value Report (CVR), Allergy Management and Inspection, patient safety such as Transfusion Prescriptions, clinical records including incomplete records and corresponding restrictions, and Clinical Quality Indicator Management. Out-of-clinical DSS includes automatic pay selection, checks for low dosage prescriptions, notification criteria such as notification criteria notice, and hospital management . DUR, a representative CDSS, provides guidance on drug prescriptions such as combination contraindications, contraindications for pregnancy and/or lactation, and the maximum duration allowed based on clinical data on accumulated drug use . The DUR was designated as a mandatory system in 2011 by the Health Insurance Review and Assessment Service in hospitals, clinics, and pharmacies.
Prescription errors form a considerable part of Medication-related errors, thus computerized physician order entry (CPOE) systems and CPOE with a Clinical Decision Support System (CDSS) are considered to be conducive to improving patient safety by reducing medication errors .
In this study, the prescription support function suggested by Korean doctors was found to be a similar DSS to prescription support systems rather than external clinical DSS. As a result of investigating the implementation of the prescription support function of the electronic medical record system, the basic information and the analysis of the prescription structure were provided by three of five companies. Interaction functionality was found to be provided by one of five vendors. If the prescription support function desired by Traditional Korean Medicine doctors is implemented in the future, the use of electronic medical records can be increased, and can contribute to the management of the information of the prescriptions prescribed by Traditional Korean Medicine institutions.
In order to conduct various studies using electronic medical records, clinical information should be created and managed in a standardized form, and term standardization should be preceded by form standardization . Standardization of these terms is also a necessary condition for clear communication between the various stakeholders involved in health care services and ensuring interoperability between systems. Prior studies that included Korean medicines in their coding include the WHO’s Herbal Anatomical Therapeutic Chemical (HATC) code, ISO-18668 (Traditional Chinese Medicine – Coding system for Chinese Medicines), and ISO / DIS 20334 (Traditional Chinese Medicine–Coding System) [22–25]. However, China’s own industrial classification is included in the code composition, and it is difficult to apply in Korea, and they have a disadvantage in that it is difficult to reflect the dosage form that is adjusted from the actual clinical practice by the code-based application.
Therefore, in order to systematically manage the prescription information from Korean medicine institutions, the most rational method was to use a combination of Korean medicines that constitute the prescription. To this end, standardization such as the name of the prescription, name of the herb, name of the formulation, and unification of the weights and measures should be available and accurate for each medicinal agent. In particular, the same prescription name was described in the survey of Korean hospitals, but the composition was different, and the method of describing the herb was different even when the same herb was considered (Figure 3). Therefore, it is urgent to standardize the name of the herbal medicine that constitutes the prescription.
In conclusion, it is necessary to develop a standardized Traditional Korean Medicine prescription terminology and format, structure the prescription of Korean medicine, and conduct verifiable research on the effects of these changes.
First, in the study on the development of standard Traditional Korean Medicine terminology, the creation of database of the name of the Traditional Korean Medicine, the dosage, preparation method terminology, terminology from both in and out of country, frequently used formula research, and manual prescription. In addition, terms that do not exist in the ‘Health Terminology Standard’ will need to go through the process of being mapped to internationally accepted terminology. This may include collection of consultation opinions, and identification and description of representative prescription names to reach consensus for entry of standard terminology.
The research on the development of standardized formatting examines domestic and foreign clinical documents and information security related to Traditional Korean Medicine, and it is necessary to develop a law, institution, infrastructure, risk review and improvement plan for the use of Korean medicine information, and to create a standard document format suitable for the Korean medicine environment.
To develop a standard Korean medicine prescription structuring program, the process of developing an algorithm for structuring Korean medicine prescription names, drawing consensus on the structure of Korean medicine prescriptions through expert meetings, and presenting of a model for developing a standard Korean medicine prescription structuring program that can be commercialized as a final result will be necessary. In addition, the prescriptive terminology standard for constructing common data model should be verified and the possibility for clinical application and practical use should be evaluated according to the standard Korean medicine prescription program.
The limitations of this study are as follows. The most difficult objective in building a Traditional Korean Medicine prescription DB is that the number and dose of herbs can be adjusted depending on the symptoms and constitution of the patient, all of which may vary considerably. In this study, it was not possible to investigate the composition and dosage of Traditional Korean Medicines. Therefore, further study is needed in this area.
Nevertheless, it is meaningful that this study explored whether it is possible to construct a diagnosis and prescription system using the CDSS system. In order to expand above research continuously and stably, it is necessary to establish an infrastructure for acknowledging the uniqueness and diversity of Korean medical care and utilizing Korean medical information in various fields. It is necessary to draw up a system of promotion through a dedicated state-led organization and to establish a council of diverse stakeholders and related experts to overcome the major issues. In addition, in order to promote the exchange of medical information of Korean medical institutions, it may be necessary to establish a legal or clinical system related to the standardization of terms and the collection and utilization of medical information records to establish a foundation for collecting and using data.
Clinical decision support had a favorable effect on prescribing treatments, facilitating preventive care services, and ordering clinical studies across diverse venues and systems .
If these data are accumulated by providing prescription support functionality after developing the Traditional Korean Medicine prescription structure program through standard terminology and formatting development, it may be possible to build a continuous cycle structure that provides enhanced clinical decision support. In addition, it may be possible to standardize and structure information on over-the-counter prescriptions, which represent uninsured items, and in the long term may be used as a secondary data source. By providing timely and standardized prescription information, it is expected these systems will contribute to the improvement of national health and medical service, and strengthen the international competitiveness of Korean medicine by securing information interoperability and improving standardization and access.