Due to the expense of doing business in the present marketplace, telemedicine will not be competitive even in the managed care environment unless it is multifunctional. The Mayo system has demonstrated since its inception that a network of communication services, although dedicated to telemedicine, finds multiple uses in an environment large enough to find applications to meet needs. A variety of management strategies were undertaken to utilize the system most efficiently. Given the great demands upon the utility for direct medical care, education, and administration, an operational structure based on clearly defined guidelines was established to allocate resources fairly, Clinicians are reliant on a sound technical system and cannot practice telemedicine in a vacuum. It is the cross functional nature of the practice and the interdependence on technology and support staff which allows for a telepresence. Telemedicine is not a medical specialty, it is both a method to access health services and a means to deliver medical care.