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While the near-term future of telemedicine development in Germany is quite clear, the long-term future has not been investigated. To determine telemedicine's long-term future in Germany, in-depth interviews were conducted with 20 key decision-makers in the German healthcare system. Interviewees included payers, doctors and their professional associations; and patients and their organizations. These individuals were asked what their expectations were in the application of telemedicine. According to the interviewees, several changes in the healthcare system as a whole will occur, which influence telemedicine. These include increase in cost pressure; the changing role of the payers and companies--as opposed to public organizations--playing a more active role in managing care. Physicians foresee more changes than payers do. Patients expect telemedicine to strengthen their role as patients. Most important telemedicine applications will be the "Gesundheitskarte" (a smart card enabling access to patient records), telemedicine as an enabling technology for other provider integration models, information systems for patients, and telemonitoring. The future looks promising for telemedicine in Germany.