Telemedicine has been studied in the intensive care unit for several decades, but many questions remain unanswered regarding the costs and the benefits of its application. Telemedicine ICU (Tele-ICU) is an electronic means to link physical ICUs to another location which assists in medical decision making. Given the shortage of intensive care physicians in the US, Tele-ICU systems could be an efficient mechanism for physicians to manage a larger number of critical care patients. This chapter will examine the current state of telemedicine in an age of rapidly expanding medical information technology and increasing demand for intensive care services. While we believe that the future of Tele-ICU is promising, there are multiple issues that must be addressed to increase the benefit of Tele-ICU. Tele-ICU is expensive to deploy and use, it may add burdens to existing intensivists, and it requires organizational and culture changes that can be difficult to accomplish.