The adoption of telehealthcare in the United Kingdom has been slow and fragmented. This paper presents a structural explanation for this by contrasting contending themes in recent UK health policy. It is argued that the conflict between trends towards modernizationand demands for evidence-based practicehave made it difficult for a major policy agency to emerge that can sponsor service development, and so proponents of telehealthcare have been forced to situate their work within the domain of R&D. This has led to a fragmented field of practice characterized by short-term and small-scale projects.