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.
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