The telemedicine demonstration was implemented principally to reduce the number of prisoners seeing local consulting specialists who come into the prisons and to reduce the number of prisoners taken outside to see specialists. Shortly after the demonstration began, it became apparent that teleconsultations had reduced the number of prisoners being transferred to Federal Medical Centers for consultations and treatment. If teleconsultations were substituted for such conventional consultations in sufficient numbers, would the costs associated with these conventional practices decline to the point of offsetting the cost of adding telemedicine resources? This chapter examines the effect on the conventional practices of specialist consultation in the three Pennsylvania prisons, where nearly all the remote encounters occurred.