Continuous flow chemistry has opened a new paradigm in both the laboratory and pharmaceutical industry. This review details the recently reported literature on continuous multistep telescoped synthesis of active pharmaceutical ingredients (APIs), inline flow downstream processing, in-process monitoring by process analytical technology (PAT) in flow, flow automation and artificial intelligence (AI) and robotics. We envisage that the integration of all these techniques can ensure an ‘ideal’ smart and efficient 21st century API chemical process that dramatically improves efficiency, agility, quality and flexibility in the manufacturing of pharmaceuticals.