Transformer- and Generative Adversarial Network–Based Inpatient Traditional Chinese Medicine Prescription Recommendation: Development Study
Authors: Zhang Hong , Zhang Jiajun , Ni Wandong , Jiang Youlin , Liu Kunjing , Sun Daying , Li Jing 
Published: April 2022

Background
Traditional Chinese medicine (TCM) practitioners usually follow a 4-step evaluation process during patient diagnosis: observation, auscultation, olfaction, inquiry, pulse feeling, and palpation. The information gathered in this process, along with laboratory test results and other measurements such as vital signs, is recorded in the patient’s electronic health record (EHR). In fact, all the information needed to make a treatment plan is contained in the EHR; however, only a seasoned TCM physician could use this information well to make a good treatment plan as the reasoning process is very complicated, and it takes years of practice for a medical graduate to master the reasoning skill. In this digital medicine era, with a deluge of medical data, ever-increasing computing power, and more advanced artificial neural network models, it is not only desirable but also readily possible for a computerized system to mimic the decision-making process of a TCM physician.

Objective
This study aims to develop an assistive tool that can predict prescriptions for inpatients in a hospital based on patients’ clinical EHRs.

Methods
Clinical health records containing medical histories, as well as current symptoms and diagnosis information, were used to train a transformer-based neural network model using the corresponding physician’s prescriptions as the target. This was accomplished by extracting relevant information, such as the patient’s current illness, medicines taken, nursing care given, vital signs, examinations, and laboratory results from the patient’s EHRs. The obtained information was then sorted chronologically to produce a sequence of data for the patient. These time sequence data were then used as input to a modified transformer network, which was chosen as a prescription prediction model. The output of the model was the prescription for the patient. The ultimate goal is for this tool to generate a prescription that matches what an expert TCM physician would prescribe. To alleviate the issue of overfitting, a generative adversarial network was used to augment the training sample data set by generating noise-added samples from the original training samples.

Results
In total, 21,295 copies of inpatient electronic medical records from Guang’anmen Hospital were used in this study. These records were generated between January 2017 and December 2018, covering 6352 types of medicines. These medicines were sorted into 819 types of first-category medicines based on their class relationships. As shown by the test results, the performance of a fully trained transformer model can have an average precision rate of 80.58% and an average recall rate of 68.49%.

Conclusions
As shown by the preliminary test results, the transformer-based TCM prescription recommendation model outperformed the existing conventional methods. The extra training samples generated by the generative adversarial network help to overcome the overfitting issue, leading to further improved recall and precision rates.