Many tertiary care centers in the USA have attempted to implement interactive television (IATV) or dynamic telemedicine systems. The advantage these systems provide is real-time interaction. The biggest disadvantage is cost: expensive hardware, band-width and personnel. An alternative to IATV is Medical Electronic Link (MEL); a low cost, store-forward, internet-based physician consultation system. MEL allows physicians in remote locations to consult physicians at the Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire by using the World Wide Web. The Benefits of MEL are low hardware and band-width costs, accessibility, a self-explanatory interface, convenience, and its use of the case record. This system has been implemented at a family practice clinic in Manchester, NH and at the Tribhuvan University Teaching Hospital in Kathmandu, Nepal.