Disclaimer: The views expressed are my own and do not represent my employer.

Introduction

For many Americans, wearables like Fitbit, Apple Watch, and Garmin are already tracking valuable data about our health and behavior. But the potential of that data is rarely realized in clinical settings. Most of it lives in isolated silos, in formats that can’t be interpreted or shared with healthcare providers. As a result, physicians still rely heavily on infrequent “snapshot” vitals taken during office visits, missing crucial opportunities for early intervention.

In 2018, Apple’s FDA-approved EKG feature with arrhythmia detection marked a turning point. It hinted at a future where wearables, connected devices, and AI give both patients and physicians deeper, real-time insights into health.

That future has a name: the Internet of Medical Things (IoMT).

What Is IoMT?

The IoMT refers to connected health devices—wearables, smart monitors, in-home sensors, medical-grade IoT—that transmit protected health information (PHI) securely over the internet.

What makes IoMT distinct from consumer IoT is its need to comply with HIPAA and healthcare-grade standards, as it handles sensitive health data. When combined with AI, these devices offer a vision of proactive, personalized, and continuous care—not just reactive treatment.

What IoMT + AI Could Deliver

The promise of IoMT is in its ability to empower physicians with real-time, individualized insights, answering questions like:

Has the patient’s condition progressed? (e.g. cancer severity)
Are there early signs of a new condition? (e.g. Parkinson’s)
Is a patient responding to treatment or medication?
Are we heading toward an adverse event? (e.g. asthma flare-up)
Is the patient adhering to care plans? (e.g. daily weights for CHF)

Even subtle trends—like a slow rise in blood pressure over months—can signal when to intervene. And when AI is trained on thousands of similar patients, it unlocks powerful pattern recognition not visible to the human eye.

So… What’s the Holdup?

With so much promise, I expected to find clinical trials galore. But when I searched ClinicalTrials.gov, I could count the IoMT trials on one hand. Why? After speaking to providers, researchers, and hospital leaders, I uncovered two big barriers: technical complexity and clinical integration.

The Technical Hurdles

Building infrastructure to collect and use IoMT data is not trivial. It requires:

HIPAA-compliant cloud infrastructure
Handling out-of-order, streaming data from spotty connections
Translating proprietary device data into a common clinical language

To be truly useful, IoMT data must interoperate with the patient’s medical record. That means normalizing data to industry standards like FHIR® (Fast Healthcare Interoperability Resources) and pairing it with clinical context (e.g., chemo infusions, comorbidities).

And every device speaks a different “language.” One calls it “HR,” another “pulse,” some send vitals one-by-one, others in bundled packets. Without standardization, the data is nearly unusable.

The Clinical Hurdles

Third-party vendors have tried to fill the gap with off-the-shelf kits and apps—but they often fall short.

Heuristic scoring systems (EWS) lack precision
Alert fatigue from false positives overwhelms nurses
Data silos prevent integration with EHRs or ML models
Workflow chaos from too many dashboards/devices

Hospitals realize quickly: they can’t manage 10 devices, 10 dashboards, and 10 disconnected patient flows. What’s needed is one unified view of the patient, across devices and time.

Add to that clinical liability, training, funding, and IT capacity—and you see why most hospitals are hesitant to commit.

What Health Systems Want (and Need)

To succeed, any IoMT solution must deliver:

Value: Does this data meaningfully improve care?
ROI: Will it pay off? In revenue, efficiency, or outcomes?
Time-to-impact: How fast can it be deployed and used daily?
Feasibility: Is the engineering and training realistic?
Usability: For both clinicians and patients
Scalability: Can it grow as new devices are introduced?
Alignment: Does it fit long-term strategic goals?

A Step Forward: IoMT FHIR® Connector for Azure

At Microsoft, we set out to remove the technical friction. We built the IoMT FHIR® Connector for Azure, an open-source tool that:

Securely ingests high-frequency, high-volume PHI
Converts device data to FHIR® standard
Operates in a HIPAA-compliant cloud (Azure)
Enables machine learning and analytics with minimal lift

This means hospitals and researchers can run lean pilots, not massive multi-million dollar infrastructure builds. Test a few devices, learn fast, and scale what works. And because the data sits in the hospital’s own Azure cloud, it’s secure, controlled, and interoperable.

Why This Matters

For healthcare to become proactive, clinicians need real-time signals. With IoMT, your provider can say:

“Jean, your asthma seems to be worsening—please use your inhaler.”

“Alex, we noticed you haven’t used your kitchen in 24 hours. Are you okay?”

That’s the future. Not replacing physicians with AI—but enhancing their visibility. Giving them tools to see trends, catch declines early, and intervene before it’s too late.

A Vision for the Future of IoMT

The Internet of Medical Things (IoMT) represents one of the most transformative frontiers in healthcare—promising to extend clinical insight beyond the exam room and into the rhythms of daily life. By capturing real-time data from connected devices, IoMT has the potential to reduce costs, detect deterioration earlier, and personalize care in ways that were previously unimaginable.

But realizing that potential requires more than just technology. It demands interoperability across fragmented systems, thoughtful integration into clinical workflows, rigorous data privacy standards, and new ways of thinking about the physician-patient relationship. The success of IoMT will hinge on solving complex challenges at the intersection of engineering, design, ethics, and organizational change.

At its best, IoMT can enable a healthcare system that is no longer reactive, but proactive—where clinicians are empowered with timely, relevant insights and patients are supported continuously, not just episodically. The future of care lies in these connections—and in our collective ability to design systems that make them meaningful.