Two modalities of practice are emerging: The real-time interactive mode and the store-and-forward mode. The combination of these modalities with the capabilities to exchange medical information as supported by the new telecommunications infrastructures places telemedicine at a central position for improving access to quality health care by all. Financial, legislative, and regulatory penalties (Center for Telemedicine Law, 2004) must continue to be removed in order to permit everyone in need to reach their goal by finding the ramp and to get onto the telemedicine highway