Using a case study approach, we conducted a retrospective review of 12 months of outpatient activity at the Princess Alexandra Hospital (PAH) in Brisbane, Australia. From our dataset we calculated two variables – the telehealth-eligible substitution rate and the overall telehealth substitution rate. Telehealth eligibility is specialty-specific and is based on clinical and geographical constraints. During the study period there were video consultations ( N = 1088) and traditional consultations ( N = 41,951). The telehealth-eligible and overall substitution rates were 17.5% and 2.5%, respectively. The overall telehealth substitution rate is substantially lower than the telehealth-eligible substitution rate. This is due to the majority of patients being from local catchment areas which are currently ineligible for video consultations at the PAH. The highest observed overall telehealth substitution rate was for the radiosurgery which had telehealth activity as a reportable key performance indicator since inception of the service, which may have contributed to the relatively high rate. In-home video consultations with patients who reside in metropolitan areas are needed to substantially increase the rate of telehealth substitution.