In case of litigation in telemedicine applications, one main issue is to determine liabilities of each physician involved in the data exchange. To achieve this goal, we propose an efficient watermarking based telemedicine protocol. Its objective is not only to ensure the security of data but also to provide evidence that an exchange took place. We show how watermarking in combination with cryptographic mechanisms and a third party can enforce data and exchange traceability. The efficiency of our solution is demonstrated by means of a security analysis.