Background: The benefits of telemedicine services are very significant to the society forrnimproving the quality and access of health in the health care delivery system. However, thernnumber of service provision sites is limited, inaccessible and the service is underutilized by thernmajority of the community due to various factors in Ethiopia.rnObjective: The objective of this research is to explore the level of telemedicine utilization, inrnTikur Anbessa Specialized Hospital.rnMethods: A cross sectional study was conducted in Tikur Anbessa Specialized Hospital fromrnFebruary to April 2013 among 422 health professionals. Quantitative data were collectedrnthrough self-administered pre-tested questionnaires and complemented by a qualitative datarnusing self interview questions and observation checklist. Quantitative data were initiallyrnentered in to EPi-3.5.1 version and exported to SPSS version 16.0 for analysis. Descriptivernstatistics, COR, AOR and 95% CI were calculated. Logistic regressions were carried out tornidentify the major predictors' of telemedicine underutilization. Qualitative data were analyzedrnthematically.rnResults: Majority of participants 65% were males and medical specialists were 56.3%. Of therntotal respondents only 40.6% used telemedicine services and 84.5% of them used the servicesrnless than five times a year. Among other factors technology (AOR=9.06 95%CI 3.08, 26.63)rnand administrative problems (AOR=3.52 95%CI 1.79, 6.95) and legal issues (AOR=2.21rn95%CI 1.14, 4.26) were identified the major predictor for telemedicine underutilization. Lackrnof internet connectivity, system unreliability, system user un- friendly and lack of users'rntechnical assistant were some of the technological barriers reported in both quantitative andrnqualitative findings.rnConclusion and recommendation: This study revealed that telemedicine services arerngenerally underutilized. Technology and administrative problems; and legal issues werernidentified as the major factors. Among technological barriers internet connectivity and systemrnreliability are the major problems identified. Knowing and identifying the factors was vital forrnconsidering future in depth studies and taking appropriate measures to fix the problems facedrnin the portfolio.rnKey words: -- Telemedicine, Technological barriers, Telemedicine utilization, Tikur Anbessa SpecializedHospital.