The pandemic permanently redrew the map of healthcare. What started as emergency telehealth adoption has evolved into an ecosystem of remote patient monitoring (RPM), AI-driven alerts, and virtual chronic care management, now deeply integrated into hospital operations. Yet as hospitals digitize their reach, they also expand their risk, and most don’t realize it.

Traditional malpractice law was written for discrete encounters: a visit, a procedure, a discharge. Remote monitoring erases those boundaries. A physician might never see the patient; data arrives continuously, and the “moment of negligence” may span hours or days. When a red alert pings at 2:13 a.m. and no one acts until morning, who is responsible—the vendor, the nurse, or the system that designed the workflow?

In Henderson v. Mercy Virtual Care (2025), a heart failure patient enrolled in an RPM program died after repeated tachycardia alerts were routed to a contractor queue with no escalation pathway. The hospital argued that staff followed the written protocol; the court found the protocol itself negligent, holding that inadequate staffing and lack of physician oversight violated the hospital’s duty to provide safe systems of care.

Hospitals face exposure on several fronts:

• Delegation and Staffing: Remote data review is often offloaded to vendors or undertrained personnel, but legal accountability remains with the hospital.

• Alert Fatigue and Escalation: When algorithms generate noise without clear thresholds or prioritization, the system—not just the clinician—can be deemed unsafe.

• Transparency and Patient Expectations: “Continuous monitoring” language in marketing or consent forms may imply 24/7 surveillance, even when no such coverage exists—creating grounds for misrepresentation claims.

• Cross-State Practice: Multi-state telemonitoring introduces licensure and jurisdictional challenges, further blurring liability lines.

Both CMS (2023) and the FDA’s Digital Health Guidance emphasize that hospitals must maintain clinical governance, validation, and performance monitoring for all digital programs. Yet audits show that fewer than half of hospitals using RPM perform regular chart audits or escalation drills. Plaintiffs’ experts are now reframing these failures as institutional negligence, not individual error.

The medicolegal standard is evolving. Hospitals can no longer view virtual care as an ancillary service – they must treat it as core clinical infrastructure subject to the same credentialing, staffing, and oversight expectations as any inpatient department. Every unacknowledged alert, every missed escalation, and every vague consent form is a potential exhibit.

The future of digital care will not be defined by how well hospitals adopt technology, but by how responsibly they govern it. In the age of continuous data, liability has become continuous too.

References

1. Henderson v. Mercy Virtual Care, No. 25-CV-414 (Mo. Cir. Ct. 2025).

2. U.S. Food & Drug Administration. Digital Health Technologies and SaMD Guidance. 2023.

3. Centers for Medicare & Medicaid Services. Remote Physiologic Monitoring and Chronic Care Management Billing Guidelines. 2023.

4. Wachter RM & Berwick DM. “Digital Medicine and the Duty to Monitor.” JAMA. 2024;331(9):824–831.

5. HHS Office for Civil Rights. Privacy and Security Considerations in Telehealth Programs. 2024.