Shelters and high-volume community clinics are among the closest veterinary parallels to human hospitals. Large numbers of patients move through these systems, and systems-level approaches to quality control, population health and efficient and judicious use of resources are needed. Yet, unlike human medicine, veterinary medicine has few tools to objectively monitor the quality or outcomes of care at a population level—whether in shelters, community clinics, or private practice. The metrics we can readily extract from our software systems— intakes, outcomes, live release rates, and length of stay—do not capture key medical measures such as infectious disease incidence, surgical outcomes, mortality in vulnerable populations, and wait times for care. In human medicine, a system without such measures would be unthinkable.