In urban and agricultural streams, assessing aquatic ecosystem health is critical due to widespread pollution. Traditional methods for evaluating attached diatoms crucial for ecosystem monitoring face limitations such as species misidentification and sample damage. This study was conducted in the Miho River within the Geum River system and highlights the effectiveness of environmental DNA (eDNA) techniques for more accurate and efficient genetic-based analysis than conventional microscopic analysis methods. When eDNA-based assessments were compared with traditional microscopic methods, this study found that eDNA analysis often revealed poorer ecosystem health. Notably, eDNA assessments showed a stronger correlation with phosphorus concentrations, underlining their precision and importance in ecological studies. These findings suggest that eDNA has potential as a valuable tool for comprehensive biomonitoring. However, the use of international genetic barcode databases in eDNA analysis could lead to the identification of unrecorded species in Korea. Therefore, this study recommends developing a localized genetic barcode database and constructing eDNA information through meta-barcoding, focusing on native species. This approach is crucial for enhancing the accuracy and applicability of eDNA-based health assessments in national biomonitoring efforts.