On the Norwegian Continental Shelf, several operators have invested in technologies that are enabling and enhancing real-time collaboration between personnel onshore and offshore in order to achieve more effective decision-making. This is thought to improve operational performance, including delivery of offshore healthcare. Frequently in offshore healthcare, distributed collaboration takes place between medical personnel belonging to different organisations. Despite advances in and use of collaboration technologies, there is still potential for improvements in the cross-organisational collaboration. A system perspective is used to address some of the issues that need to be considered for successfully enhancing cross-organisational collaboration in telemedicine.