A low-cost usability engineering methodology (heuristic evaluation combined with small-scale expert assessment) is examined in the context of the design and development of a Web-based telemedicine system. Six experts - three human-computer interaction (HCI) experts and three medical-content experts - examined the Spacebridge to Russia Web site for usability. The HCI experts identified 52 interface problems using a set of ten usability criteria or heuristics; these problems ranged in severity from cosmetic to a major failure. The content experts completed a series of six simple tasks while describing their actions. The usage difficulties were related to the HCI problems identified and were primarily characterized by a mismatch of the designer model and the content expert model. This heuristic/usage methodology can provide an incremental benefit in a variety of other design activities. It is suggested herein that the combined heuristic/usage methodology should be included as a standard design component of dynamic telemedicine systems.