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There are two reasons for doing something. One is a very good reason and the other is the real reason.-Spanish proverb CONVENTIONAL WISDOM ATTRIBUTES the slow implementation of telemedicine largely to high capital and operating costs-the expense of equipment, software, and transmissionwith only the promise of a break-even, let alone profitable, return on investment. While telecommunication technology and communication costs continue to decline, this advantage has been offset by declining health care revenues. The cost obstacle remains.By this reasoning, telemedicine should thrive in institutions where bottom-line concerns, although important, are not paramount. Indeed, NASA and the U.S. Armed Forces have been leaders in creating, initiating, and implementing innovative telemedicine projects. But as funding from Congress becomes more tenuous for these institutions, as well as for others de-Address reprint requests to:

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