Telehealth is used widely in both developed and developing countries addressing the barriers of poor access to health and quality of care. However, use of technology in extreme weather conditions and geographical terrains, and in resource-constrained settings still remains a challenge. This paper describes successful implementation of Telehealth initiative in Gilgit-Baltistan, located in the heart of Karakorum and Himalayan ranges in Northern Pakistan. Main objective of the project was to support healthcare providers in remote areas through online patient consultations and capacity building. Four primary care centres (staffed by lady health visitors and nurses, but no doctors) were connected with three secondary care centers (having a family physician) using mobile connectivity (GPRS and EDGE),while secondary care facilities were connected to a specialized medical care facility via DSL connection. Computers, cameras, and diagnostic equipment were provided to all centres. Health facilities used an open source, store-and-forward program called 'iPath' to send cases to next level facility for diagnosis and treatment. In the first eight months of its operation, over 300 cases were diagnosed and treated using eHealth. Capacity building programs for health providers were also initiated utilizing e Learning solutions, such as Moodle and Elluminate Live. The current project has shown evidence of success and aimed to be scaled up to other health facilities in Northern Pakistan.