Mind the Gap: Pharmacy’s Future as AI Evolves in Health Care

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Introduction

Declaration of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this work, the author used Claude 3.5 Sonnet to provide editorial feedback to improve clarity and readability. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the content of the published article.

Artificial intelligence (AI) has made significant inroads into health care, demonstrating capabilities that complement and challenge traditional pharmacy practices. For instance, AI tools trained on clinical notes from electronic health records (EHRs) provided clinical predictions—including in-hospital mortality and 30-day readmission—with accuracy exceeding state-of-the-art risk scores.1 AI interpretation of routine imaging (eg, chest x-rays) has the potential to provide comprehensive disease risk assessments, including risk of heart attack, stroke, and diabetes.2 Electrocardiogram interpretation by an AI tool, flagging high-risk patients and notifying physicians, was found to reduce patient mortality.3 Additionally, patient assessments of responses to their questions found that those from AI chatbots were of higher quality than those from physicians.4

Turning to pharmacy, current and future AI applications include drug safety, pharmacy operations, precision medicine, drug reference navigation, clinical surveillance, and electronic clinical quality measures.5,6 Looking forward, AI has the potential to use comprehensive patient-specific data such as EHRs, imaging, omics, and real-time monitoring data, in combination with medical domain expertise built on a foundation of medical literature to support caregivers in a variety of clinical tasks.7

As these AI-driven innovations continue to integrate into medical and pharmacy practice, critical questions emerge: What becomes of the pharmacist’s role? Where can the pharmacist fit into this new paradigm to provide value supporting safe and effective medication use? To see the path forward, it is helpful to first look backward.

Pharmacy’s Historical Adaptability

The pharmacy profession has a long history of evolving to meet health care needs. Over the decades, we have witnessed the emergence of specialized roles—drug information specialists, informatics pharmacists, and pharmacogenomics specialists—that did not exist previously but were created to address specific needs in the health care system. When a gap was identified between the health care team’s capabilities and the patient’s needs, pharmacists developed the drug information, information technology, and genomic expertise to fill those needs.

Illustrations of pharmacy’s adaptability are limited to not only the emergence of new roles but also the evolution of skills required for the role of any pharmacist. Before the emergence of electronic medical records (EMRs) and computerized physician order entry (CPOE), pharmacists were routinely tasked with interpreting handwritten prescriptions. Due to the influx of hurriedly scribbled prescriptions, pharmacists needed to accurately interpret such prescriptions to maintain efficient pharmacy operations. This skill, which was only tangentially related to medication expertise, became essential for pharmacists then. With EMRs and CPOE, this skill has all but vanished from the modern pharmacist’s arsenal. Computer skills are another example. While these had little value in pharmacy about 40 years ago, now they can dramatically impact the productivity of a pharmacist. Valuable skills for pharmacists will continue to evolve, and what present-day skills will become obsolete remains to be seen.

Adaptability has been a hallmark of the pharmacy profession, allowing pharmacists to remain integral to health care teams despite technological and systemic changes. As we stand on the brink of an AI alteration in health care, this adaptability will again be tested.

Emerging Gaps, Evolving Roles, and Preparing for an AI-Enhanced Future

As AI reshapes the health care landscape, new gaps will emerge between AI’s capabilities and patients’ needs. Given the plethora of possibilities, the challenges of regulatory approval, and the complexity of implementing new technology into health care delivery, it is nearly impossible to predict where AI will impact practice. If the dawn of AI in health care looks anything like the emergence of technology into any other industry, it will not fulfill its full potential in one fell swoop. Imperfect AI applications will emerge sporadically and improve iteratively over the years. This means that the gaps for pharmacists are likely unpredictable and unstable.

In the setting of this uncertainty, high-level skills that are broadly useful to a diverse set of scenarios will be most valuable. The following tasks are well-suited to leverage pharmacists’ clinical expertise while incorporating new technological competencies: AI education and implementation, loop oversight, human-on-the-loop oversight (quality assurance), and interdisciplinary collaboration (Table).6,8 To thrive in this evolving landscape, the pharmacy profession must proactively prepare for an AI-enhanced future through education and continuous learning, hands-on experience, and advocacy and leadership.

Conclusion

The arrival of AI in health care presents challenges and opportunities for the pharmacy profession. Although some traditional roles may be transformed, pharmacists have the potential to adapt and evolve alongside these technological advancements.

By embracing change, acquiring new skills, and positioning themselves at the forefront of AI integration in health care, pharmacists can continue to fill crucial gaps in the health care system. The future of pharmacy in the AI era is about leveraging technology to enhance capabilities and improve patient outcomes.

About the Author

Steven Smoke, PharmD, is the clinical informatics pharmacist at RWJBarnabas Health in West Orange, New Jersey.

The AI transformation in health care represents a significant shift in how we approach medication management and patient care. By actively engaging with these changes and helping to shape the integration of AI in health care, pharmacists can work toward maintaining a crucial role in the evolving health care ecosystem.

REFERENCES
  1. Jiang LY, Liu XC, Nejatian NP, et al. Health system–scale language models are all-purpose prediction engines. Nature. 2023;619(7969):357-362. doi:10.1038/s41586-023-06160-y
  2. Topol EJ. AI-enabled opportunistic medical scan interpretation. Lancet. 2024;403(10439):1842. doi:10.1016/S0140-6736(24)00924-3
  3. Lin CS, Liu WT, Tsai DJ, et al. AI-enabled electrocardiography alert intervention and all-cause mortality: a pragmatic randomized clinical trial. Nat Med. 2024;30(5):1461-1470. doi:10.1038/s41591-024-02961-4
  4. Ayers JW, Poliak A, Dredze M, et al. Comparing physician and artificial intelligence chatbot responses to patient questions posted to a public social media forum. JAMA Intern Med. 2023;183(6):589-596. doi:10.1001/jamainternmed.2023.1838
  5. Wong A, Wentz E, Palisano N, et al. Role of artificial intelligence in pharmacy practice: a narrative review. J Am Coll Clin Pharm. 2023;6(11):1237-1250. doi:10.1002/jac5.1856
  6. Smoke S. Artificial intelligence in pharmacy: a guide for clinicians. Am J Health Syst Pharm. 2024;81(14):641-646. doi:10.1093/ajhp/zxae051
  7. Moor M, Banerjee O, Abad ZSH, et al. Foundation models for generalist medical artificial intelligence. Nature. 2023;616(7956):259-265. doi:10.1038/s41586-023-05881-4
  8. Nelson SD, Walsh CG, Olsen CA, et al. Demystifying artificial intelligence in pharmacy. Am J Health Syst Pharm. 2020;77(19):1556-1570. doi:10.1093/ajhp/zxaa218

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