The implementation of AI in community pharmacy in Scotland, as in any healthcare setting, raises several ethical concerns that need careful consideration. As more and more AI products come to the healthcare market, it won’t be long before we see familiar brands and new startups offering AI solutions for the pharmacy. Before you sign the papers and pay the fee here are the key concerns to contemplate:

What is AI?
Artificial Intelligence right? well not quite, more like “really clever programs made by pretty clever humans”. Our current AI, in short, is computers looking at piles of data, and working things out based on preset concepts of what it should be looking for. 

In AI we tell the computer “here is a picture of blue pills and red pills” the AI doesn’t “know” what a blue pill is, it doesn’t even know what blue is. So the human has to say, “this is blue, this is a pill” then the AI will in time be able to correctly identify all blue pills and all red pills. The more data the computer gets the better it will become at guessing which is which.

What does this mean in terms of what AI is? Well it’s a giant data collection system, playing guess who.

I asked ChatGPT, one of the more commonly referenced AI’s available on the market right now to summarise the above, 

"AI is like a smart computer assistant that learns from examples to help with various tasks, such as recognizing images or understanding language”

Before we take a gander around how we might use our new assistant in our pharmacies let first take a look at some concerns and considerations.

Patient Privacy and Data Security - Informed Consent:

AI systems often rely on vast amounts of (hopefully anonymised) patient data. Ensuring the privacy and security of this data is critical to maintaining patient trust. To safeguard patient information pharmacies must make sure they comply with data protection laws and ethical standards.

On the back of this, patients should be informed about the use of AI in their healthcare, including how their data will be utilised. Obtaining informed consent is crucial, and patients should have the option to opt out of AI-driven services if they wish.

Bias, Transparency & “Explainability”:

An inherent problem posed by AI is the presence of biases in training data, which can lead to unfair or discriminatory outcomes, especially where the training data does not fully represent all sectors of our diverse population. It's essential to regularly audit and address bias in our current and future data collection practices, to ensure fair and equitable treatment of all patients.

The majority of the general population can find AI decision-making processes difficult to understand. Therefore, it is critical to ensure transparency in how AI systems reach conclusions. The explanations provided must be simple and able to be understood by the majority of users, and should also be explainable by practitioners when asked for more information. This means that healthcare professionals, as well as patients, must be able to understand how AI is being used in their field. This is vital for trust and accountability.

Imagine you are trying to sign a patient up to a new service, they’re going to ask you questions, how does it work, what does it cost, etc. Now imagine you are trying to explain the same service but you’re not actually sure what it does or how it works, and you need to ask the manager about the price. Not only is that a really rubbish customer experience, it’s also going to put people off from using the service. In fact it can result in people becoming more suspicious of the service offered.

If you can’t easily explain the AI to someone else, what it’s doing for your Pharmacy or how it’s helping the patient, you can’t expect patients to want to use these services. 

Professional Autonomy & Quality of Care, Job Displacement & Ongoing Training:

AI is a tool that should augment, not replace, the decision-making of healthcare professionals. There should be a clear delineation of roles, with pharmacists retaining the autonomy to make clinical judgments and decisions based on their expertise. Pharmacists must continue to utilise best practices and be able to “override” the AI recommendations where appropriate.  There is a risk of over-reliance on AI, leading to a decline in the quality of human interactions and personal care, especially in a pharmacy setting, where pharmacists are consistently pressed for time and resources by an overworked healthcare system. Balancing the use of technology whilst maintaining a patient-centred approach is crucial. Clear lines of responsibility and accountability should be established for the outcomes of AI-driven decisions. Determining who is responsible in case of errors or adverse events is critical for maintaining patient safety.

The implementation of AI in pharmacy can inherently be perceived as a risk to jobs. However, the goal is to use AI to improve workflows, automate tasks and, by proxy, provide more opportunity for healthcare professionals to provide patient care, by pivoting their roles away from “human computing”.
Ethical considerations include ensuring that employees are provided with training opportunities to adapt to new technologies and are shown the benefits to their workflow and best practices gained by utilising AI.

Pharmacy professionals will need ongoing training to understand and use AI technologies effectively. Ensuring access to education and support for pharmacy staff is paramount to optimal implementation.

Equitable Access and the long-term Impact on Healthcare Dynamics:

Ensuring that AI is accessible and beneficial to all members of the community, regardless of socioeconomic status, is an ethical consideration. Disparities in access could exacerbate existing healthcare inequalities –especially as community pharmacy covers a variety of socioeconomic areas of Scotland and the wider UK. There is particular concern towards how those who have low access to technology would fare in this data-service driven world. 

Asking your elderly customers to “just use an app” when they may not even have access to a phone that is capable let alone know how to use the service, can be isolating and off-putting for many older customers or those with accessibility issues. 

Now this might not apply if the AI is being used within the pharmacy for monitoring and flagging for example, but it's definitely a worthy consideration if you’re signing up to any new offers that have a patient facing portal or service. 

The widespread adoption of AI in community pharmacy may reshape the dynamics of healthcare delivery. Ethical considerations should include assessing the long-term impact on patient-provider relationships, trust, and the overall healthcare ecosystem.

Independents provide a key role in our healthcare service, face to face interactions. No amount of technological development will replace the genuine interaction between two humans explaining something with each other. However, that isn’t to say there isn’t a place in Community Pharmacy for AI, and that place will probably lie in freeing up resources so you can continue to have those conversations on the shop floor. 

Addressing these ethical concerns might sound a little mind numbingly boring, or perhaps you feel you don’t have time to consider what it might mean for your patients, but every inch of new advancements requires a collaborative effort involving healthcare professionals, policymakers, technologists, and the community. to establish ethical guidelines, regulations. The continuous monitoring of this budding technology will be essential to ensure the responsible and ethical use of AI in community pharmacy in Scotland.