Although many studies have been published concerning clinical telemedicine, little information is available about emergency department (ED)-based telemedicine programs. An ED-based telemedicine program was initiated in April 1996 involving the National Cheng Kung University Hospital (NCKUH) and the Provincial Peng-Hu Hospital (PPHH) under a pilot project supported by the Department of Health. This is the first telemedicine program for remote offshore island service in Taiwan. The program is synchronous in nature to the practice of telemedicine. The role of the emergency physician includes giving initial suggestions, arranging consultations, coordination, and the organization of other medical tasks, such as accompanying some of the transfers. During the 12-month period, this system was used in 275 consultations, including 24 specialty and/or subspecialty department/sections, and more than 100 members of the medical staff have participated in this project since. In a survey, 89.4% of physicians in the PPHH and 82.2% of the physicians in NCKUH rated the system as very comfortable to work with and satisfactory. According to these observations, an ED-based telemedicine program is a feasible method for carrying out remote consultations. Successful development of the partnership and program of telemedicine is based on the active participation and coordination of the medical personnel and technicians between the cooperating hospitals.