Telemedicine can provide great improvements to health care delivery in islands and remote areas, where it can bring high-quality care, often not or poorly available. The islands of Procida and Ischia, in the gulf of Naples, are well known resorts in South Italy. The little hospital of Ischia and especially the outpatient department of Procida are not always equipped to face all clinical cases. Regularly, the patients from Procida were directly transferred to the mainland, even only for diagnosis. The small size of the health service structures is related to the small population of the islands. This problem is more perceived during the summer season with the tourist invasion. A cardiological and radiological video-teleconsulting system, which connects the two islands to mainland hospitals (Pozzuoli and Giugliano), has been established. This telemedicine network allows a 24-hour connection between the main hospitals of Pozzuoli and Giugliano and the islands' health centres. This telemedicine solution aims to provide a prompt and qualified health service in the islands, and to reduce the risks and the costs of patient transportation to the mainland. Technology assessment activities are carried out in order to evaluate and measure the performance of the specific telemedicine solution during its operative work. The preliminary results are promising, waiting for more extensive data to carry out cost-effectiveness analysis, a cost-comparison analysis was attempted. This project represents a pilot and demonstration site for future applications of telemedicine in emergency.