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Serious mental illness (SMI) is a chronic condition that require long term pharmacological treatment. Adherence to oral antipsychotic medication has specific nuances that plague patients and physicians alike. For SMI patients, nonadherence increases their risk of hospitalization and relapse. Nonadherence is a formidable barrier to physicians in accurately assessing medication efficacy and helping a patient achieve their fullest potential. A digital adherence system approved by the FDA can provide near real-time Aripiprazole ingestion information. The system records ingestions through an embedded ingestible sensor in oral Aripiprazole , which sends a transient local signal to a patch worn on the patient’s torso that is then stored on a paired smartphone App. With patient permission this data can be viewed remotely by their physician, along with a patient’s mood, activity, and time spent resting. Such data can: reveal broad patterns of medication adherence behavior to the patient themselves as well as their physician; may help physicians and patients understand and create more realistic expectations for adherence, expanding discussion of treatment options; as well as minimizing therapeutic appointment time devoted to determining actual adherence, thereby maximizing the time available to address each patient’s distinctive reasons for being (non)adherent. Crucially, extra time created during appointments can be used to strengthen the therapeutic relationship, which may translate into both improvement in adherence and patient attitude to their medication. Future investigations are needed to examine how this technology impacts the physician-patient relationship to develop training and provide best practice guidelines for its use. Otherwise potential benefits of this technological advance may be lost, or worse still, inadequate and inappropriate use may harm the therapeutic relationship.