Recent advances in networking, robotics, and computer technology allow today real-time diagnosis, consultation, and education by using images obtained through remote microscopy. This paper presents a new approach in telepathology, the Image Guided Decision Support (IGDS) system, which integrates components for both remote microscope control and decision support. Using the Micro-Controller component the physician can command a robotic microscope from the distance, obtain high-quality images to be used in the diagnosis, and authorize other users to visualize the same images. The image understanding-based Decision Support component of the system locates, retrieves and displays cases which exhibit morphological profiles consistent to the case in question and suggests the most likely diagnosis based on majority logic. The IGDS system has a natural man-machine interface containing engines for speech recognition and voice feedback.