Innovative methods are needed to deliver nursing care for an increasing number of people with chronic conditions who require assistance to stay in their own homes. The purpose of this pilot study was to assess the practicality, suitability, safety and costs of delivering daily home medication management by videophone. Elderly clients with cognitive impairment, and clients receiving Directly Observed Therapy (DOT) for tuberculosis were recruited, and over a period of 6 months, 9 clients had broadband and IP Videophones installed in their homes. Nursing protocols and a backup system with the nursing field service were developed. Results showed that clients with mild to moderate cognitive impairment, multiple medical problems and who lived alone were able to use the service. The clients and Call Centre staff viewed the videophone service positively, medication management was delivered safely, and the service was time and cost-efficient compared to a home visit by a field nurse. The videophone service enabled increased continuity of delivery of medication management on weekends and public holidays, more flexibility of timing to suit the clients, and Call Centre staff were able to address other health issues through the videophone. To conclude, for selected clients, a medication management service delivered by videophone offers an effective alternative to the traditional drive-around visit. The videophone service has potential to be scaled up and to link to other health service providers.