Technology-based innovation requires long-term changes to workforce routines, otherwise practices will not be sustained. The aim of this study was to identify influential factors in the ongoing use of an acute stroke telemedicine programme. A constructivist approach using an exploratory case study was undertaken. Interviews with metropolitan and regional clinicians involved in the Victorian Stroke Telemedicine (VST) programme pilot were undertaken. The pilot site was a regional hospital, with a catchment population of almost 308,000, approximately 200 km from Melbourne, Australia.