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NASA flight surgeons have routinely relied on telemedicine to augment inflight medical care since the Gemini program. The current telemedicine capability aboard the Space Shuttle is limited to two-way voice communication, one-way video, and telemetry of ECG and spacecraft parameters. This capability has been sufficient to manage the routine minor medical problems that have occurred in-flight, but long-duration Space Shuttle and International Space Station missions are likely to be accompanied by more serious medical contingencies. In the event of emergent crew health problems, NASA flight surgeons will require an improved capability to provide a rapid, accurate assessment of an ill or injured crewmember. Onboard systems will supply flight surgeons and medical specialty consultants with real-time voice communication, medical video, and data.