Background: Telemedicine has demonstrated to improve access and quality of health services in underserved area, curtailing the costs, therefore its application to the delivery of health care in prison would be desirable. Little is known about its use across European penal institutions. Our study aimed to assess the state of telemedicine within the European jails. Methods: To maximize data availability, we used two different approaches. A bottom-up approach was used by gathering information directly from prison directors of every single penal establishment of the 28 European members. A top-down approach was used to collect information from persons involved in prison administration or project leaders at national level. In both approaches questions were sent by mail. Results: Information gathered directly by contacting prison directors and/or persons in charge come from all the 28 EU members. In total, we contacted 211 prison directors and 116 persons in charge, with a total response rate of 67%. We have found that telemedicine, as additional healthcare delivery model, is used only in 11 countries, especially among members of Northern and Western Europe. Only Romania showed to have a pilot project for a nationwide program of telemedicine. Conclusions: Telemedicine services among European penitentiaries appear still poorly developed. Given the numerous and demonstrated advantages of this technology, it would be desirable to implement its utilization in penal healthcare and to integrate it in the routine services, as benefit not only for prison environments but also for the whole community of each country.