More than 280,000 patients are treated by hemodialysis in the USA. The first-year annual adjusted mortality is very high and, in part, relates to the dose of the delivered dialysis (Kt/V). Using multimedia telemedicine, we have been following dialysis patients for over one year with a weekly "telemedicine visit" in addition to weekly physician visits, in an attempt to maintain compliance with the dialysis schedule, in addition to comprehensive medical consultation. Transmission is achieved with T1 lines from the clinic to the physician's office or home. The telemedicine session uses electronic patient folders containing relevant medical details, digitized X-rays, lab values, etc. We are able to achieve high-quality videoconferencing, capture still or video images, record remote stethoscope sounds, capture local or remote data and modify the medical record. Our goal is to increase the quantity of delivered dialysis and thereby improve quality of life and patient satisfaction, and reduce the costs of medical care, at the same time maintaining patient confidentiality. Appropriate measures to ensure data integrity and patient confidentiality have been integrated into the study. Questionnaires are also utilized to measure, on an ongoing basis, quality of life and patient satisfaction, while a weekly questionnaire captures any medical event taking place. The project is nearing completion, with subsequent data analysis to take place in the following six months. The system and procedures we have employed are accepted enthusiastically by patients and staff alike, and have aided in patient management.