We have examined aspects of the development of telemedicine and telecare in Japan. Despite Japan's reputation as an integrated and technocratic country, the diffusion of telemedicine has fallen below expectations, notwithstanding the urgent need to solve the problems of an ageing society. There has been a fragmentation of objectives and perspectives within the corporate (manufacturing) sector and within the policy sector of central and local government. There has also been a broader fragmentation between manufacturers, government and users (doctors and hospitals). As a result, the success or failure of individual projects appears to depend not on the quality of the technology, and often not on the evident importance of the social need, but on the overall coherence of a complex socio-technical system.