Intro/background: The NHS Long term plan calls for “digital-first” solutions, however, many good innovations fail. Barriers to digital innovation in healthcare are well-rehearsed and often predictable. This paper aims to highlight issues to be considered in implementation. Methods: It is a qualitative study of experiences of telehealth implementation. Findings: Staff engagement is crucial to acceptance; compatibility with existing practises helps but where impossible, pathway redesign is necessary. There is a notion that staff of any grade can become digital champions, yet the role is challenging for staff without power. Funding systems can restrict adoption due to associated savings impacting elsewhere in the system. Organisational support for innovation is often apparent but does not trickle down to service level sufficiently. Conclusions: Senior management needs to lead on and support at a micro level the implementation of digitally enabled health care. Funders and commissioners need to recognise that innovation takes time and that measured approaches are more successful.
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