Sustainable rural telehealth innovation: a public health case study.

OBJECTIVE To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable. STUDY SETTING Longitudinal, qualitative study (1988-2008) of the largest public health district in Georgia. STUDY DESIGN Case study design provided deep insights into the innovation's social dynamics. Punctuated equilibrium theory helped present and make sense of the process. We identified antecedent conditions and outcomes, and we distinguished between episodes and encounters based on the disruptive effects of events. DATA COLLECTION Twenty-five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials. PRINCIPAL FINDINGS Strong collaboration within the district, with local community, and with external partners energized the process. Well-functioning outreach clinics made telehealth desirable. Local champions cultivated participation and generative capability, and overcame barriers through opportunistic exploitation of technological and financial options. Telehealth usage fluctuated between medical and administrative operations in response to internal needs and contextual dynamics. External agencies provided initial funding and supported later expansion. CONCLUSIONS Extensive internal and external collaboration, and a combination of technology push and opportunistic exploitation, can enable sustainable rural telehealth innovation.