This project followed a clear sequence of events in three stages: (1) Definition and validation of a minimum technical standard for telemedical consultation in A&E; (2) An assessment of the safety and clinical effectiveness of a telemedical system employing these standards, through a prospective, randomised clinical trial; (3) A cost-effectiveness analysis of telemedicine within the A&E environment. The process of standards definition and validation was undertaken in collaboration with Bristol University's Institute for Learning and Research Technology. X-rays and still images were evaluated at the stages of capture, compression, transmission and display, both objectively and through the use of an expert panel in A&E. The results were analysed in conjunction with information on file size, transfer times and data loss to define a minimum technical standard. In stage two a telemedicine system conforming to the above standard was formally evaluated through a prospective, randomised and blinded study. 600 patients were assessed via the telemedicine link, by a general practitioner and also by an on-site A&E specialist, allowing a series of independent treatment plans to be drawn up and subsequently compared with a gold standard. Each patient was randomly assigned to follow one of these plans and reviewed 5 to 10 days later. A wide range of data, incorporating clinical, financial and satisfaction outcomes were collected at this time. Stage three was conducted in collaboration with the department of Health Economics at Bristol University, and took the form of a cost minimisation analysis. This was conducted from the point of view of the NHS and patients and their families, and included a comprehensive sensitivity analysis.