Digital health services increasingly cross-national borders, yet legal uncertainty persists over how to regulate telemedicine across jurisdictions. In September 2025, the European Court of Justice delivered a landmark ruling on the case ‘DrSmile’ (C-115/24), clarifying the EU Cross-Border Healthcare Directive 2011/24/EU and defining the difference between purely remote and mixed ‘hybrid’ models of telemedicine. The Court held that a provider established in one Member State may deliver telemedical care across the EU under the professional and patient-safety rules of the provider’s country, while any in-person treatment remains governed by the patient’s country law. It further defined telemedicine as care delivered entirely at a distance by electronic means and confirmed that the provider’s country-of-origin rule extends beyond reimbursement; in particular to licensing, oversight, and safety standards. We analyse these rulings in the broader context of EU regulatory fragmentation and cross-border consumer protection, evaluating their implications for patients, telemedicine businesses, traditional practitioners, and public health policymakers. Finally, we consider how this decision could reinforce the importance of international standards for digital health governance and the lessons it offers to the US, UK, and other non-EU countries.