A case study is reported of a local health community that has created a Frail Elderly Pathway with the aim of treating elderly patients in their own homes who might otherwise be admitted to hospital. The development of the Frail Elderly Pathway is a sociotechnical systems challenge that requires a multi-strand programme involving process, organisation and technical developments. The experience of delivering the pathway is reported and demonstrates the difficulty of creating temporary virtual acute care teams with members from different agencies. The degree to which integrated care can be delivered is seen as dependent upon a variety of electronic health systems being in place that enable real-time sharing of patient information. Teleheath equipment has been purchased as part of this development but it is not widely used. The paper concludes that, in an immature service, the practices needed to make rapid and appropriate use of telehealth facilities are not yet in place.