Abstract: The results of the CSIRO National Telehealth trial were recently released and very widely publicised. In a Before and after Controlled Intervention (BACI) design involving >230 patients, the keynote results included a reduction of 46% in the rate of expenditure on medical services after one year, a 53.2% reduction in the rate of admission to hospital and a 70- 76% reduction in the rate of LOS. Patient acceptance of the technology was >83%, and >89% of care coordinators would recommend telemonitoring services to other patients. The return on investment, calculated as the ratio of net benefit to net cost of providing the telemonitoring service was estimated to be between 5-6 times. These results strongly suggest that new models of care for the management of chronic disease in the community, based on at home telemonitoring and care coordination can improve healthcare outcome and reduce hospitalisation in both urban and rural and remote settings. Longitudinal vital signs data and periodic patient administered clinical questionnaires provide powerful tools for early identification of an exacerbation of a patient ’s condition and permit the early mobilisation of clinical resources to avoid unnecessary hospitalisation. In this paper we consider the consequences of this trial for the delivery of health services in rural and remote communities and discuss whether at -home or community health centre based telehealth could alleviate the impact of clinical shortages, overcome the tyranny of distance and facilitate better patient self -management and healthcare outcomes. Given the lack of clinical specialists in rural and remote communities, the ability to connect to specialists in urban and regional centres becomes a critical necessity. Whilst traditional telehealth systems provide a good baseline for the provision of tele monitoring services, are they sufficient to support remote specialist consultations in emergency settings? We will discuss a blueprint for telehealth solutions for mobile community nursing as well as telehealth services that can be delivered from community health centres under remote medical supervision.