The use of telemedicine services, such as telestroke, is still highly fragmented and its deployment in an integrative healthcare system is challenging. Factors impeding the growth of telemedicine include confidence and malpractice issues, technical advances, reimbursement, licensing, credentialing costs, cost effectiveness, and legal issues. These barriers, limitations and requirements in the routine use of telemedicine are reviewed, in addition to medical activities, the objectives of telestroke, technical aspects, funding, legal issues, evaluation and quality management. As telemedicine induces a new form of interrelationship between health care providers, mutual trust and acceptance need to be developed in telemedicine services. Furthermore, education and training will be crucial in order to facilitate the use of telestroke over the next decade.