Designing Prescription Verification Systems That Know When the Pharmacist Must Take Over

Prescription-verification systems increasingly combine rules, clinical knowledge bases, predictive models, and workflow automation. Yet the central safety problem is not simply whether a system can classify a prescription as high or low risk. It is whether the system can recognize when its output is insufficient for continued automation and responsibility must transfer to a pharmacist. Confidence-only automation is inadequate because a high score may coexist with poor calibration, missing clinical context, conflicting evidence, unusual patient–therapy combinations, vulnerability, or high-consequence decisions. This article proposes a non-empirical Prescription-Verification State Model linked to a Pharmacist-Takeover Trigger Framework. The model separates context assembly, automated checking, evidence reconciliation, clarification, pharmacist takeover, adjudication, disposition, and lifecycle monitoring. Takeover is organized around six proposed trigger classes: uncertainty, conflicting evidence, missing context, unusual combinations, vulnerable patients, and high-consequence decisions. A related takeover contract specifies the reason for escalation, unresolved information, urgency, completed checks, required professional action, fallback behavior, and documentation. Evaluation must extend beyond model discrimination to calibration, trigger sensitivity, missed takeover, unnecessary takeover, timing, workload displacement, interface comprehension, subgroup performance, and post-deployment change. Governance must define authority for activation, modification, suspension, requalification, and retirement. The framework is an original conceptual synthesis rather than a validated clinical system, guideline, or regulatory standard. Its trigger logic, state transitions, thresholds, and responsibility boundaries require empirical testing in specific pharmacy settings before decision use.