Objective To analyze the operation and management of telemedicine services in secondary hospitals in China, and to provide scientific basis for the effective operation of telemedicine in secondary hospitals. Methods The probability proportionate to size sampling (PPS) was adopted to investigate the telemedicine operation and management in secondary hospitals across the country from August to October 2018. Chi-square test and analysis of variance were used to compare the differences in telemedicine operation and management of secondary hospitals in different regions. Results The telemedicine operation and management information of 187 secondary hospitals in 29 provinces, autonomous regions and municipalities were collected from the survey. The number of telemedicine staff in secondary hospitals was mainly between 0 and 5, and the annual investment was mainly under 20 000 yuan, accounting for 49.17%. And 69.52% of secondary hospitals adopted a completely self-managed operation model, and 65.24% of secondary hospitals had established telemedicine private network. The main types of telemedicine services conducted in secondary hospitals were remote consultation, remote education and remote specialist diagnosis, and 83.42% of secondary hospitals had implemented remote comprehensive consultation services. Conclusion The secondary hospitals mainly adopted independent operation mode to carry out telemedicine service in China. Most hospitals have established telemedicine private networks and carry out remote consultation services. However, the construction of telemedicine management department, network and information systems, and the application of telemedicine services in secondary hospitals need to be further strengthened.