title: Sustainable rural telehealth innovation: a public health case study.
abstract: OBJECTIVE
  To examine adoption of telehealth in a rural public health district and to explain how the innovation became sustainable.
  
  
  METHODS
  Longitudinal, qualitative study (1988-2008) of the largest public health district in Georgia.
  
  
  METHODS
  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.
  
  
  METHODS
  Twenty-five semistructured interviews with 19 decision makers and professionals, direct observations, published papers, grant proposals, technical specifications, and other written materials.
  
  
  RESULTS
  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.
authors.affiliation: Center for Process Innovation, J. Mack Robinson College of Business, Georgia State University, 35 Broad Street, NW, Suite 400, Atlanta, GA 30303, USA. rsingh@ceprin.org
authors.forename: Rajendra
authors.initials: R
authors.lastname: Singh
authors.forename: Lars
authors.initials: L
authors.lastname: Mathiassen
authors.forename: Max E
authors.initials: ME
authors.lastname: Stachura
authors.forename: Elena V
authors.initials: EV
authors.lastname: Astapova
mesh_terms: D001292:Attitude to Computers; D003299:Cooperative Behavior; D005845:Georgia; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D007407:Interviews as Topic; D008137:Longitudinal Studies; D017146:Models, Organizational; D011634:Public Health; D015980:Public Health Practice; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D018581:Technology Transfer; D017216:Telemedicine / Q000706:statistics & numerical data* / Q000639:trends; D013997:Time Factors
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