Most pulmonologists don’t think of “prescription renewals” as a high-stakes part of care.
Until you’re staring at a COPD patient who stopped their maintenance inhaler because the refill ran out, the portal message sat unread, and the next appointment isn’t for six weeks.
Utah is now piloting a different model: letting an AI system renew prescriptions (for a limited set of medications) with no physician interacting with the patient in real time.
This is not a thought experiment anymore….
The real problem: refills are a care gap, not an admin task
In outpatient pulmonary medicine, we live in chronic disease management:
COPD
Asthma
OSA
Pulmonary hypertension
ILD
A lot of our outcomes depend on boring, repetitive things happening reliably:
Patients staying on controller meds
Follow-up tests happening on schedule
Side effects and contraindications getting caught early
But the refill workflow is built on reactive inbox work. When refills expire, patients often don’t escalate. They just stop.
That is the moment “practice management” becomes clinical care.
What Utah is doing with Doctronic (nuts and bolts)
Utah’s Office of Artificial Intelligence Policy signed a 12-month, time-limited regulatory mitigation agreement that allows Doctronic’s AI to participate in prescription renewals.
Key points that matter for practices:
This is mitigation, not endorsement. Utah explicitly says it is not endorsing the technology.
Limited scope: renewals for previously prescribed medications only.
Limited formulary: the pilot covers 190 medications and excludes higher-risk categories. For pulm, that includes common meds like albuterol, albuterol-ipratropium, budesonide, budesonide-formoterol, fluticasone, fluticasone-salmeterol, fluticasone-vilanterol, montelukast, and tiotropium (i.e., the bread-and-butter asthma/COPD lineup).
Verification-heavy workflow: patients must create an account, verify identity, and verify the prescription (including photo-based verification and secondary checks).
Staged safety oversight: early renewals undergo structured review, and pharmacists can escalate renewals for physician review.
In other words, Utah is trying to replace the “refill inbox” with a standardized, auditable workflow.
Why pulmonologists should care (even if this starts in primary care)
Pulmonary patients are exactly the population where renewals turn into bad outcomes:
Controller inhalers get stopped.
Nebulizer meds lapse.
Steroid bursts become a substitute for maintenance therapy.
COPD and asthma exacerbations rise.
If an AI renewal workflow reduces refill friction, pulmonologists may see:
Fewer “I ran out” visits.
Better continuity on maintenance therapy.
Less staff time chasing faxes and portal back-and-forth.
But, in pulmonary medicine, “routine refill” is rarely purely routine.
The clinical edge cases that will hit pulm practices first
For pulmonologists, the danger zone isn’t “AI renews an albuterol inhaler.”
It’s when renewals become untethered from the follow-up triggers we rely on:
The severe asthma patient who is overusing rescue meds.
The COPD patient who needs spirometry reassessment.
The OSA patient who is non-adherent but keeps getting supplies renewed.
The ILD patient whose symptoms are slowly worsening but keeps “passing” a scripted questionnaire.
We should assume the majority of harm, if it happens, will come from:
Missed clinical deterioration.
Missed monitoring.
Missed opportunities to adjust therapy.
The malpractice question isn’t theoretical
If the AI system renews a medication and something goes wrong, responsibility gets murky fast:
Is it the platform?
The named prescriber-of-record?
The pharmacist who filled it?
The practice that had been managing the patient?
Politico reports Doctronic says it secured a malpractice policy covering an AI system, intended to hold it to a physician-level responsibility standard.
That may help, but it doesn’t fully solve the day-to-day reality: most of us practice defensively when the liability map is unclear.
What pulmonology practices should do now (practical takeaways)
If AI renewals spread, the winning practices will be the ones who build guardrails that keep renewals connected to clinical follow-up.
A few practical steps:
Tie renewals to objective monitoring
Spirometry intervals
Exacerbation frequency
CPAP adherence metrics
Oxygen needs
Build “renewal triggers” that force re-engagement
Automatic visit prompts after X steroid bursts
Lab or vitals triggers for meds with monitoring needs
Clarify your stance on external renewals
If patients use third-party renewal workflows, decide what your practice will and won’t manage afterward.
Train staff on the new failure modes
The risk shifts from “lost refill request” to “silent refill continuation.”
In summary
Utah’s Doctronic pilot is an early proof-of-concept for something bigger: AI moving from documentation and triage into actual prescribing workflows.
For pulmonology, the upside is real: fewer medication lapses and less refill chaos.
But the risks are real too: chronic disease management depends on follow-up, monitoring, and nuance. If AI renewals scale without guardrails, we will see the edge cases in our clinics.
If you want the full breakdown of the pilot structure, liability implications, and why renewals are the perfect “test case” for autonomous AI, see the original Healthcare Huddle article here.