中药饮片智能化事前审方系统应用与思考

Application and thinking of intelligent pre-examination system of Chinese herbal pieces

我国《处方管理办法》规定药师应当对处方用药适宜性进行审核。由于中药饮片组方复杂、多元,至今还没有成熟的中药饮片处方的审方软件应用于临床的报道。中药饮片处方的审核停留在药师人工审方阶段,其介入点都在事中审核和事后点评,不能做到临床医师开方与临床药师审方在同一时段实施,即事前审方,且由于药师的中医辨证论治能力和经验不同及审方时间的限制,事中审核难免遗漏不合格处方。上海市杨浦区中医医院与上海市文献馆合作研发的"中药临床审方系统",将中药饮片审方的介入点提前在"事前",实现"事前"审方的智能化,结合人工的"事中"和"事后"审核点评,形成了中药饮片处方的事前实时干预、事中互动审方和事后点评分析一体化的全程监控,大大提高了中药饮片处方的合格率。应用比较研究法,总结和分析2018年人工审方组与2019年"中药临床审方系统"的智能化审方组的审方结果。"中药临床审方系统"比人工审核中药饮片处方具有明显优势,优势在于审方介入点提前至"事前"环节,不合格处方的发现率明显提高。"中药临床审方系统"智能化审方较人工审方在提升中药饮片临床合理用药方面有较大优势,具有实用和推广价值。

China’s Prescription Management Measures stipulates that pharmacists shall examine and verify the appropriateness of drug use of prescription medication. Due to the complexity and diversity of TCM decoction piece, there has been no sufficient clinical report on the application of TCM prescription preview software. TCM prescription audit now stays on pharmacists’ artificial trial stage. The points of intervention are reviewed in the middle and afterwards. It cannot be implemented in the same time when the prescription is prescribed by the clinician and previewed by the clinical pharmacist, which is called the preview of prescriptions. Due to the different abilities and experience of pharmacists in TCM treatment based on syndrome differentiation and the time limit of prescription preview, unqualified prescriptions are inevitably omitted during the review. Shanghai Yangpu District Hospital of TCM developed by cooperating with Shanghai Literature Pavilion "TCM Clinical Prescription Preview Audit System" was used to realize the intellectualization of the examination in advance to put forward, formed the real-time intervention. It realizes the intellectualization of "preview" prescription, combines manual "middle" and "afterwards" review and comment, and forms the whole-process monitoring of preview real-time intervention, reviewed in the middle and afterwards intervention, which greatly improves the rational rate of TCM prescriptions. The results of artificial group reviewed in 2018 and intelligent system reviewed in 2019 were applied to the method of comparative study. "TCM clinical prescription preview audit system" has obvious advantages over manual preview of TCM prescriptions. The advantage lies in that the intervention point of prescription review is advanced to the "preview" point, and the detection rate of unqualified prescriptions is significantly improved. Compared with the manual method, the intelligent method of TCM clinical prescription preview system has a great advantage in improving the rational clinical use of TCM prescriptions.