This paper examines published research on Information and Communications Technology (ICT) Outsourcing and uses this as a framework through which to examine the delivery of ICT services at the South West Alliance of Rural Hospitals, an environment not without challenges. Right from the beginning the CIO appointed to the Alliance decided to address these challenges by implementing a high speed telecommunications network to reduce the costs of data, voice and video communications within the Alliance. The emergence of the truly virtual health care network in Victoria’s South West supported by external service providers but managed by a small yet powerful central ICT team holds a number of useful lessons for the delivery of services in start up cooperative organisations, particularly regional, rural and remote (R3) organisations.