The lack of understanding of what is truly critical to the success of emerging health services innovations may result in the failure of those innovative projects. This is particularly true in the case of HIT innovations struggling for reimbursement recognition, willing early adopters, and attention of over-extended IT departments. With the help of a seven-year longitudinal case study, we use empirically rooted critical success factors (CSF) framing to explore and identify the key facilitators and interim outcomes associated with the implementation of telemedicine in the form of a telestroke extension to a hospital network and how these CSFs in turn address the telestroke implementation specific challenges.