Objective Qualitative studies can help us to understand the `successes' and `failures' of telemedicine to normalize within clinical service provision. This paper presents the development of a robust conceptual model of normalization processes in the implementation and development of telemedicine services.

Design Retrospective and cumulative analysis of longitudinal qualitative data from three studies undertaken between 1997 and 2002. Observation and semi-structured interviews produced a substantial body of data relating to approximately 582 discrete data collection episodes. Data was analyzed separately in each of three studies. Cumulative analysis was conducted by constant comparison.

Results (1) Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor. (2) Adoption of telemedicine systems in service depends on successful structural integration so that development of organizational structures takes place. (3) Translation of telemedicine technologies into clinical practice depends on the enrolment of cohesive, co-operative groups. (4) Stabilization of telemedicine systems in practice depends on integration at the level of professional knowledge and practice, where clinicians are able to accommodate telemedicine through the development of new procedures and protocols.

Conclusion A rationalized linear diffusion model of telehealthcare is inadequate in assessing the potential for normalization, and the political, organizational, and `ownership' problems that govern the process of development, implementation and normalization and so need to be accounted for. The paper presents a model for assessing the potential for successful implementation of telehealthcare services.This model defines the requirements for the successful normalization of telemedicine systems in clinical practice.