In this paper we present the principles of a new platform developed for handling ECG signals in a telemedicine setting. We focus on three basic services: an ECG file management system (acquisition, storage, transmission); ECG-oriented teleconferencing; and realtime transmission of ECGs over the telephone network. This work has been carried out in the context of national and EU-sponsored projects. Its main purpose was to help patients from remote or isolated areas, like small islands, with insufficient health-care services, to get appropriate and experienced medical care directly from large central hospitals. We present the design and the basic operations of the ECG handling system.