Healthcare delivery in the northern periphery of Europe is challenged by dispersed populations, geographical complexities (including mountainous terrain and inhabited islands), ageing populations, and rising patient expectations. It is challenged further by variations in transport networks and information communication technology infrastructure. This article provides an overview of e-health development across the northern periphery areas of four northern European countries (Finland, Sweden, Norway, and Scotland) by summarizing the outcomes of a mixed methods e-health mapping exercise and subsequently identifying service needs and gaps. A total of 148 applications, with a range of applied e-health solutions, were identified and the findings have promoted the sharing and transfer of e-health innovation across the four countries. The supporting telecommunications infrastructure and development of innovative telemedicine appear slower in sparsely populated areas of Scotland in comparison to its northern peripheral counterparts. All four countries have, however, demonstrated a clear commitment to the development of e-health within their remote and rural regions.