Telemedicine is not a simple technology but a context-dependent innovation implying significant process modifications. Despite the growing interest in telemedicine implementation, it still does not form part of the healthcare organizations' recurrent activities due to several obstacles. The neglect of process change is one of the renowned barriers. This work's originality lies in using the "process innovation" concept as an analytical tool to understand the telemedicine implementation issues from the process change perspective. The qualitative method is chosen based on five telemedicine acts through two case studies in France, a university hospital, and a network of expertise. Findings indicate that implementation requires context adaptation at the level of technology, culture, and strategy. The interaction of these determinants with change enablers and hinders creates the implementation paradigm. In conclusion, we should emphasize the implementation as a whole rather than distinct elements. Managers may prepare the context and integrate the enablers, but the main task is defining an implementation strategy benefiting the stakeholders. This work fills the literature gap in using the process innovation concept to analyze telemedicine implementation challenges and contributes to understanding the context adaptation. It also provides practical implications about the implementation conditions from the process change perspective.

远程医疗不是一项简单的技术，而是一项依赖于环境的创新，意味着对流程进行重大修改。尽管人们对远程医疗实施的兴趣越来越大，但由于存在一些障碍，它仍然没有成为医疗机构经常性活动的一部分。忽视流程变化是著名的障碍之一。这项工作的独创性在于使用“流程创新”概念作为分析工具，从流程变革的角度理解远程医疗实施问题。定性方法的选择基于五项远程医疗行为，包括法国的两个案例研究、一家大学医院和一个专业知识网络。调查结果表明，实施需要技术、文化和战略层面的环境适应。这些决定因素与变革推动者和阻碍因素的相互作用创造了实施范式。总之，我们应该强调作为一个整体而不是单独的元素来执行。管理人员可以准备背景并整合促成因素，但主要任务是定义有利于利益相关者的实施战略。这项工作填补了使用流程创新概念分析远程医疗实施挑战方面的文献空白，并有助于理解上下文适应。它还从过程变更的角度提供了有关实施条件的实际意义。管理人员可以准备背景并整合促成因素，但主要任务是定义有利于利益相关者的实施战略。这项工作填补了使用流程创新概念分析远程医疗实施挑战方面的文献空白，并有助于理解上下文适应。它还从过程变更的角度提供了有关实施条件的实际意义。管理人员可以准备背景并整合促成因素，但主要任务是定义有利于利益相关者的实施战略。这项工作填补了使用流程创新概念分析远程医疗实施挑战方面的文献空白，并有助于理解上下文适应。它还从过程变更的角度提供了有关实施条件的实际意义。