The size of dairy farms has changed dramatically over the last 20 years. As dairy farms continue to grow and change, the role of the dairy practitioner will continue to evolve. Veterinarians are no longer the individual responsible for treating sick animals on many dairy farms today. Mid-sized and larger farms are increasingly performing more treatments themselves while using the veterinarian as a resource for developing and monitoring treatment protocols. This paper will briefly outline current monitoring protocols used to manage transition dairy cows, expose the weaknesses of those protocols, and present a review of published data to support novel monitoring concepts. A group of large dairy farms located in the Midwestern United States who own and manage approximately 40,000 dairy cows will be used as a case example to outline implementation of the novel monitoring concepts and to look at the possible effect on cow behavior.