Telehealth offers an exciting opportunity for observation medicine. It offers the same high quality patient care, but the patient is remote from the provider. Telehealth can be utilized in many ways such as centralizing patient care to a single provider and/or combining inter-hospital observation units. This larger tele-observation unit could allow for separate observation billing creating increased revenue for physician services. Creation of tele-observation requires a diverse group of stakeholders from information technology, observation medicine, telemedicine, and nursing to create a streamlined process for patient care and technical details. Due to the Covid-19 pandemic reimbursement is unchanged when using telemedicine for observation care but expect changes as the public health emergency ends. Telemedicine and tele-observation will use will likely expand and therefore should be incorporated into residency and continuing medical education training.