Your client's phone says the dog is declining. Your exam says he's fine. Which one do you chart?

Continuous data from smart collars and litter boxes is exposing subclinical decline single visits miss, and creating a new liability question practices haven't answered.

Your client's phone says the dog is declining. Your exam says he's fine. Which one do you chart?

Photo: Kit (formerly ConvertKit) · Unsplash

A dog walks into the exam room moving normally. The owner pulls out their phone: months of mobility data from a wearable device show a gradual decline in activity, and videos reveal increasing stiffness after rest.

Which patient gets diagnosed, the one in front of us, or the one in the dataset?

The plain answer: we're now diagnosing both, and there's no protocol for it

Veterinarians have historically made clinical decisions based on snapshots, physical exam findings, diagnostic results taken in the clinic on that visit. Those snapshots are increasingly being supplemented by continuous data streams collected outside the practice: smart collars tracking daily steps and heart rate variability, smart litter boxes logging urination frequency and duration, continuous glucose monitors showing post-meal spikes, and client videos capturing intermittent lameness or coughing that never shows up during the appointment.

"We're seeing a new type of client, one that is hyper-connected and much more informed, and that is generating and has access to much more information," says Adam Little, DVM, who focuses on the intersection of technology and animal health. He believes we are seeing the early phase of a reimagination of the typical veterinary visit.

Home-generated data can provide a fuller picture of a patient's health. Since it is collected when a pet feels relaxed and secure, it may also provide a more realistic glimpse into its everyday activity and physiologic parameters. Eleanor Green, DVM, a passionate advocate for veterinary innovation, puts it this way: "Veterinary data has shifted from a passive, retrospective approach to active, real-time decision-driving infrastructure. The data are no longer confined to the clinic visit."

The technology itself is no longer niche. According to a 2024 survey, most pet owners are ready to embrace pet tech. Home health monitoring provides a wealth of data that can lead to earlier detection of subtle changes, more personalized care plans, and better monitoring and management of chronic conditions.

The caveat: integration burden, liability exposure, and questions no one has answered yet

The problem is not whether the data exists, it does, and clients are bringing it. The problem is what a working DVM is supposed to do with it, in a ten-minute appointment slot.

Smart litter boxes use cameras, artificial intelligence, and app controls to collect data including frequency and duration of litter box visits, urine output, weight, and posture. Some varieties use facial recognition to distinguish among multiple cats and can send notifications about prolonged periods of inactivity, possibly alerting owners to a urinary blockage or constipation. Data collected by smart litter boxes can help veterinary teams detect changes that can be early indicators of conditions such as kidney disease, urinary tract infections, gastrointestinal disease, and diabetes.

Wearable devices, available as smart collars, harnesses, or tags, can monitor daily steps, activity level, sleep patterns, vital signs such as heart rate and respiratory rate and temperature and heart rate variability, and even excessive scratching or licking. Continuous glucose monitors, though not yet manufactured specifically for pets, have been used successfully in veterinary patients for some time using human versions. "Wearables are especially valuable when there are subtle, continuous changes that precede obvious changes," Dr. Green says. They are particularly helpful in monitoring parameters in pets with chronic diseases, such as activity levels in pets with osteoarthritis or respiratory rate in pets with heart disease. For pets with diabetes, she notes, pet owners can monitor glucose and see that after a particular treat the number goes up.

Client-shared photos and videos can be helpful in triaging pet owner concerns, evaluating abnormal behaviors such as limping or coughing or seizures or aggression, monitoring postoperative patients, and performing rechecks. Viewing photos and videos stored in the medical record allows veterinarians to monitor progress over time, such as the healing of a chronic wound or the progression of lameness. Visuals can often improve diagnostic accuracy when symptoms aren't visible in the clinic.

But here is the liability question we're hearing more often: if a client brings months of wearable data showing subclinical decline and the clinician does not review it, or reviews it and dismisses it, and the patient deteriorates, what does that chart note look like in a negligence claim? And if the data is trusted and intervention happens based on a device that has not been validated in a peer-reviewed study, is that practicing medicine or reacting to a gadget?

Dr. Little recommends first ensuring that image submissions are easy for clients to make and can be stored and accessed by veterinary teams. "Can they send it via text, or do they need to log into some weird website in order to upload a photo, but it can only be two megabytes, and half of them fail?" he adds. "Do you have the ability to actually see them, search them, and have them in your medical records?"

The same question applies to wearable datasets. The integration burden falls on the practice, and we're not seeing standard workflows yet for how to ingest this data or how much appointment time to allocate to reviewing it.

What practices are doing

The trick is figuring out how to pare down weeks or months of information into key data points and how to incorporate that data into clinical patient care. Here are a few approaches practices are using:

Help pet owners understand baseline patterns. Veterinary teams should help pet owners understand their pet's baseline patterns so they are better prepared to recognize noteworthy changes. They can also coach clients in setting alerts for follow-up monitoring of health conditions.

Create expectations that make clients feel engaged. "Start to create expectations for clients that make them feel engaged in the process," advises Dr. Little. "So, 'Hey, we're sending Fluffy home. I want photos.' I want to keep track, and I would rather have that visibility and that kind of engagement." Taking photos and videos can often help pet owners take an active role in their pet's health.

Use the data to justify earlier intervention. Smart collars and app-based logs allow pet owners to track their pet's activity, food intake, treats, and weight. Playing an active role in their pet's health can help improve client compliance with weight-loss and exercise plans and alert them to concerning changes. Seeing exactly what, how much, and how often a pet eats can help veterinary teams counsel pet owners on making healthy choices during nutrition consultations. As part of a weight management plan, this data can help teams see what does and does not work for an individual pet and make adjustments. Early adopters are using continuous data to justify earlier intervention and more personalized care plans.

Guide clients, do not push back. Dr. Little believes that more data can lead to more empowered clients, earlier intervention, stronger veterinarian-client relationships, and more, not less, veterinary care. "Find opportunities to harness the engagement and enthusiasm people have for their pets," he suggests. "Don't push back against clients who want to use these tools to help their pets, guide them. If you can meet them there, there is a huge opportunity to create significant value for that person."

Understand the cyber security exposure. Many of these vendors want to integrate directly into the practice information management system, and that is where the real exposure sits, according to Clint Latham, JD. If a breach occurs on the smart device side and there is a direct connection into the PIMS, that can quickly become an entry point into the broader practice. The best course of action is to review the terms of service and end-user license agreements to understand where the data lives, how it is secured, and how that integration is handled.

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Practices that embrace better-informed clients and use data effectively can deliver more personalized, proactive care. The standard of care is shifting underneath the snapshot exam, whether or not the workflow has caught up. The question is not whether to engage with client-generated data, clients are already generating it, but how to build a practice policy that protects both the patient and the chart.

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Source: Today's Veterinary Business

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