Keith J. Kaplan, MD, Attending Pathologist at Evanston Northwestern Healthcare and Assistant Professor of Pathology at Northwestern University Feinberg School of Medicine, Chicago. The technology and the rationale for utilizing telepathology are rapidly evolving, including the development of national and international networks improving patient care and increasing cost-effectiveness. As telecommunications and imaging technology concurrently advance, newer platforms will deliver performance essentially indistinguishable from that of microscope-derived diagnoses. Telepathology will be discussed in terms of the five items for innovation spread: (1) communication and influence (2) economic costs and benefits (3) knowledge barriers and learning (4) feasibility of techniques offered for the demands of the users and (5) clarification of the legal status and other factors concerning international collaboration. Acquisition cost and the operating costs are compared with potential cost-savings and other benefits. This analysis may help to decide whether or not telepathology should be established in your organization.