The US healthcare system’s dirty secret is that only about half of patients take their medications as prescribed (aka medication adherence). This prevents patients from adequately managing their chronic conditions and costs the US healthcare system billions annually in preventable hospitalizations and complications. As a result,digital devices for monitoring whether patients are adherent to their medications have been developed. Smart inhalers log every puff for asthma and COPD patients, recording date, time, and technique quality through built-in sensors and Bluetooth transmission. Digital pills embed ingestible sensors that transmit confirmation signals when stomach acid activates them, though adoption remains limited due to cost and patient acceptance issues. Smart pill bottles use cap sensors to detect opening events, while connected injection pens track insulin doses for diabetics. The pattern across all these devices is identical to other patient-generated data: the technology works, manufacturers tout impressive data capture rates, but almost none of it flows into EHRs. As a result, these technologies are exciting to technologists imaging a Star-Trek inspired future but are not likely to have a major impact on medicine.