This article contends that the take up of telemedicine results inevitably in the reconfiguration of the existing work practices and socio-material relationships. This new way of working triggers a variety of shifts in coordination mechanisms, work processes and power relationships in the health care sector. The paper, which is based on the findings of a research project conducted in Northern Italy, addresses three critical issues of telemedicine: the conflict between the scripts embodied in telemedicine technologies and the daily work practices of heath care professionals; the tendency of telemedicine to produce a delegation of medical tasks to non-medical personnel (and to artifacts); and the tendency of telemedicine to modify the existing geography within the health care environment. The paper contends that telemedicine presupposes and entails some significant changes in work processes which affect both the material conditions of the expertise which is supposed to be distributed, and the relationships between health care professionals and their practices.