We review some early efforts, designs, and technologies in the late 1970s used to plan a network of primary and secondary facilities linking up with a tertiary care center electronically and organizationally. Also reviewed are related efforts of the same period involving distance learning in remote villages in Alaska and providing training, emergency medicine, and social services at Cook County Jail in Chicago. Commercial development of teleradiology, and some procedural and organizational consequences, dating from the same period through the present, are covered as well.

Any service activity involving information lends itself to networking. This allows the sharing and more efficient allocation of resources, and overcoming many of the bounds of distance.We point out the inevitability of the virtual diagnostic hospital and the possibility of at least some aspects of virtual therapeutic hospitals.These ideas are updated to argue that they are now of compelling plausibility, being somewhere on the road between “crazy” and “obvious”.

As has always been the case for changing paradigms, there will be both problems and opportunities and some are explored. Some of the consequences of these issues for the practice of medicine, the provision of services to remote areas, and the economics and legal aspects of the new healthcare structures that emerge are considered.