I’ve sat in the Chief Information Officer (CIO) seat at several hospitals and watched clinicians make rounds, nurses chase call lights, and administrators build dashboards full of data. Unfortunately, much of that data arrives too late to drive real-time clinical decisions.
The uncomfortable truth is we were excellent at documenting what happened to patients, but far less equipped to know what was “happening” to them, in real time, between clinician visits.
Most in health IT call this the “monitoring problem,” but I call it the visibility gap. A nurse checks vitals at 10:00 PM and charts it. The next check isn’t until 2:00 AM. What happens in those hours in between is real, but it doesn’t exist on paper until someone catches it.
THE ROUNDING ILLUSION
For decades, the standard of care has included scheduled vitals checks (typically every 4-8 hours) in a medical-surgical unit. We built entire workflows, staffing models, and documentation systems around this interval. And for most of the twentieth century, it was a reasonable proxy for awareness.
It is no longer sufficient.
Deterioration rarely announces itself on schedule. Sepsis begins hours before it’s visible. A patient’s respiratory rate climbing from 16 to 22 breaths per minute is a signal that a 4-hour check might catch, but that a continuous stream wouldn’t miss. The deterioration index, early warning scores, rapid response systems, all of these are attempts to compensate for a fundamental structural gap: we are not watching patients the way we need to.
The nursing workforce burnout makes this worse. Vacancy rates above 15% in many health systems mean the nurses are stretched across more patients, with less time for the informal spot checks that once filled the gaps between formal documentation. The safety net we rely on, a nurse’s instinct, a hallway glance, a conversation at the bedside, is thinner than it’s ever been.
LIMITS OF REMOTE PATIENT MONITORING (RPM)
The RPM industry grew rapidly during and after the pandemic, and for good reason. Keeping patients connected to care between visits is demonstrably valuable. Chronic disease management, post-acute follow-up, and cardiac monitoring are supported with evidence, though reimbursement pathways continue to evolve.
Traditional RPM has a design flaw in the inpatient setting: it requires active patient participation and, unfortunately, wearables fall off. Patches generate alarm fatigue. Patients disconnect leads. Elderly patients with cognitive impairment or acute illness are the least capable of cooperating with the devices most likely to benefit them.
The innovation that deserves attention, and that health system leaders should understand, is passive physiologic monitoring. The category is not new, but the maturity has arrived. These systems use radar, infrared, or camera-based technology to continuously measure vital signs without any patient contact. No wires, no wearables, nothing to charge. No compliance problem. The patient simply exists in the space, and the measurement happens.
Radar-based systems carry an advantage over camera-based alternatives. They are inherently privacy-preserving. No image is captured, no video is stored, and no identifiable data is generated. The sensor detects motion and physiologic waveforms, nothing more. For health systems navigating patient consent, HIPAA governance, and the growing public sensitivity around surveillance in care settings, this distinction matters. Passive does not have to mean “being watched.”
For health system CIOs and Chief Nursing Officers (CNOs), this reframes the conversation entirely. Instead of asking “how do we get patients to wear the device?” the question becomes “how do we integrate a continuous signal into the clinical workflow?”
THE INTEGRATION QUESTION IS THE REAL ONE
I’ve learned, in multiple CIO roles, that technology adoption in healthcare lives or dies at the clinical workflow level. A device that generates useful data but exists outside the nursing workflow is not a clinical tool. It is a science project.
The path forward for passive monitoring (continuous observation) runs through the integration of nurse call systems, HL7 ADT feeds, alert-threshold governance, and a serious conversation with nursing leadership about what they actually want to be notified about. The last point is not trivial. Alert fatigue is a genuine patient safety risk. Adding a new stream of continuous data without thoughtful filtering doesn’t reduce noise; it multiplies it.
The health systems that are getting this right are the ones treating passive monitoring as a data architecture decision, not a procurement decision. They’re asking: Where does this signal live? Who acts on it? What does escalation look like? How do we measure whether it’s changing outcomes?
THE LEADERSHIP OBLIGATION
Here is what I would tell my former CIO self: The gap between what we document and what we know about our patients is not a technology gap. It is a leadership gap.
The technology exists. The integration pathways are understood. The reimbursement environment, while still evolving, is directionally favorable. What health systems need now are leaders willing to ask the harder questions, about workflow redesign, about alarm governance, about what it means to truly monitor a patient rather than periodically check on them.
Studies show continuous monitoring in med-surg units can cut annual average hospital costs by 14% (~$6.8M), with one peer-reviewed study of 20,000+ patients documenting $2.3M saved from 367 fewer ICU days. The ROI case is not aspirational. It is published.
We haven’t been missing vital signs because they don’t exist. We’ve been missing them because we never built a system designed to catch them in real time.
Nayan D. Patel is a healthcare IT executive and former hospital CIO, and currently the SVP/GM of Transformation & Digital Health at Neteera. Bringing firsthand operational perspective from across for-profit, non-profit, and private equity-backed organizations, his work focuses on enterprise IT strategy and commercializing emerging health technologies. Nayan is an Adjunct Professor at Southern Methodist University, a DallasCIO ORBIE Award Finalist, and the author of The Glass is Full (TGIF) Newsletter on LinkedIn. Connect: www.linkedin.com/in/nayandpatel
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