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While prior research has examined how telemedicine projects can be successfully implemented, how these operational projects evolve and change, and therefore increase and expand their impact on healthcare delivery, has received little attention. This paper addresses this research gap by examining telemedicine from a knowledge management perspective. Knowledge management projects are organizational efforts to leverage the application of their knowledge assets. Telemedicine is framed as a form a virtual collaboration, placing particular emphasis on the application of knowledge to improve healthcare delivery outcomes. Teleconsultations, a particular type of telemedicine involving complex collaborative activities, are studied in order to provide insights into how these virtual collaboration efforts can evolve and improve over time. Findings from a study of sixteen teleconsultation projects from four different telemedicine networks highlight the key characteristics of and critical challenges faced by teleconsultation projects as they attempt to evolve and expand their impact on healthcare delivery.