AI-Driven Digital Transformation in Global Healthcare: From Hospital Systems to Pharmacy Benefit Managers
Mahendran Chinnaiah
Abstract
Artificial Intelligence (AI) is revolutionizing global healthcare by enabling intelligent automation, proactive patient monitoring, and data-driven clinical and operational decisions. This study explores the AI-driven digital transformation across the healthcare continuum, with a focus on hospital systems and pharmacy benefit managers (PBMs). In hospital environments, AI technologies are enhancing electronic health records (EHRs), clinical decision support systems (CDSS), diagnostic imaging, and hospital logistics through machine learning and natural language processing. Simultaneously, AI is reshaping PBMs by enabling real-time claims adjudication, fraud detection, drug formulary optimization, and AI-assisted medication management. The interplay between hospital and pharmaceutical domains is strengthened by interoperable data infrastructures and predictive models that facilitate coordinated, patient-centered care. This study employs a structured literature review and integrates contemporary case studies to highlight global adoption trends, including AI-enabled clinical pathways in Europe and smart pharmacy logistics in North America. It also critically examines the challenges posed by algorithmic bias, regulatory frameworks such as HIPAA and GDPR, and cross-platform interoperability. By synthesizing current developments and ethical considerations, this work presents actionable recommendations for the scalable and equitable deployment of AI in healthcare.
Keywords
Artificial Intelligence; Digital Health; Hospital Information Systems; Clinical Decision Support Systems; Pharmacy Benefit Managers; Electronic Health Records; Predictive Analytics; Healthcare Automation; Machine Learning; Health Informatics; Reinforcement Learning; Ethical AI; Explainable AI; Healthcare Interoperability; Drug Distribution Optimization.
Cite This Article
Chinnaiah, M.(2025). AI-Driven Digital Transformation in Global Healthcare: From Hospital Systems to Pharmacy Benefit Managers. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 2: Mar-Apr 2025, Pages 381-386 URL: https://www.ijscia.com/wp-content/uploads/2025/04/Volume6-Issue2-Mar-Apr-No.869-381-386.pdf
Volume 6 | Issue 2: Mar – Apr 2025
