Although process measures of care have traditionally been used to assess the quality of healthcare, there is little evidence, for the majority of healthcare activities, to support a clear relationship between processes of care and resulting health gains. Outcomes monitoring is increasingly being advocated as a vital component of healthcare, particularly with the increasingly aging population. A consensus is emerging that routine systems of outcome monitoring are fundamental to rational clinical decision-making and public policy.There are several issues that need to be considered when implementing a routine system of outcome monitoring; this article addresses these issues in older people within a UK community setting in the context of an innovative observational feasibility study (The North East Fife Outcomes Project). This projectdetermined which outcomes of health and social care are the most important to this patient group; andidentified appropriate measures for relevant outcomes suitable for use in a community setting.Key patient characteristics and relevant clinical and social care process variables were then recorded, concomitant variables such as disease severity and comorbidities were taken into account and quality-of-life assessment measures recorded. For the success of any outcomes monitoring system, feedback to end-users is important. The North East Fife Project will assess the feasibility and value of feedback at the individual patient level and at the aggregate level.More research, particularly from large observational studies, is needed to address reliability and validity issues, biases and inaccuracies with routinely collected data and to further determine the value of routine outcomes monitoring.