This chapter is based on a study of the characteristics that drive successful and unsuccessful telemedicine programs. In 2000 the International Society for Telemedicine (ISfT) asked AMD Telemedicine to present our observations of what characteristics appeared to be common to successful telemedicine and telehealth programs. To find out, AMD Telemedicine conducted a study of over 60 telemedicine programs in three countries. During this review, we identified ten basic points and documented successful and unsuccessful approaches to each. There are exceptions, but the approach to each of these issues appears to maximize the likelihood of success or failure. The findings were initially presented to the ISfT membership at their conference in Denmark. The study has been updated continuously as new information becomes available. The most current observations are as follows.