The evolution of seismic structural-health monitoring (S²HM) of buildings in the USA is described in this chapter, emphasizing real-time monitoring. Rapid and accurate assessment of post-earthquake building damage is of paramount importance to stakeholders (including owners, occupants, city officials, and rescue teams). Relying merely on rapid visual inspection could result in serious damage being missed because it is hidden by building finishes and fireproofing. Absent visible damage to a building’s frame, most steel or reinforced-concrete moment-frame buildings will be green-tagged based on limited visual indications of deformation, such as damage to partitions or glazing. Contrary, uncertainty in judging extent of structural damage may lead an inspector toward a relatively conservative tag, such as a red tag. In such cases, expensive, intrusive, and time-consuming inspections may be recommended to building owners (e.g., following the M_w 6.7 1994 Northridge, Calif., earthquake, approximately 300 buildings were subjected to costly inspection of connections (FEMA 352)). Using real-time data-driven computation of drift ratios as the parametric indicator of structural deformation and damage to a structure could be of great value to minimize potential judgmental errors in such assessments. Recorded sensor data are an indication of performance, and performance-based design standards stipulate that the amplitude of relative displacement of a building’s roof (with respect to its base) indicates performance. Establishing sound criteria for performance is the most important issue for S²HM process, and since 2000 (in the USA), using real-time computed drift ratios and acceptable threshold criteria form the basis for almost all applications in S²HM.