Recent improvements in technology have had a major impact on how we communicate with patients and deliver health information and care. The authors outline the ways in which telemedicine can lead to healthcare cost savings while improving patient care. JUSTIN COLLINS AND DUDLEY BACKHOUSE W ikipedia defines communication as:The How do patients want us to communicate in the 21st century, and what has changed? There are undoubtedly many changes currently going on within the NHS, being driven by political and economical needs as well as changing trends outside of healthcare. One of the biggest changes is how people communicate and have adapted to the accessibility of information on the internet that has torn down the boundaries of control.Delivering health information in the 21st century is no longer about how patients want us to communicate, but rather how best we can plug into their existing communication. However, it is also true that when driving forces align, they are more likely to happen, so can modern technology deliver political will, benefits to patients and cost savings? INCREASING EFFICIENCY IN COMMUNICATIONOne key driver for any technology uptake is the increased efficiencies that can be realised.Technology reacts to service customer needs, rather than the technology shaping the customer. We can therefore look at trends in other sectors to see how change in communication is taking shape. Increasingly, businesses communicate via video conferencing, which adds richness compared to audio telephone calling, while realising cost savings.With the advent of new devices such as smart phones and tablets (eg the iPad 2), the sender and receiver have increased mobility. This increased access to communication and information in