Telehealth is critical to the welfare of a large percentage of seafarers. The populations are remote and have a history of poor medical care largely due to inaccessibility. Throughout the years this barrier has been broken down first with the discovery of the radio with most of the remainder broken after the advent of real time satellite communication. Medical care to populations at sea continues to evolve but significant constraints still remain, such as limitations to the amount of bandwidth available to ships at sea. Outside this constraint we have largely moved past the proof of concept phase to provide high quality medical care at sea. Almost any technology can be adapted to be used at sea (either in real time or in a store-and-forward capacity), however, future decision-making and research and its applications deserve to be examined utilizing a specialized maritime framework. The framework should examine existing technologies and new technologies considering telemedicine best practices combined with the constraints brought by the current state of maritime health and technology infrastructure.