Table 1 Main themes and domains for facilitators and barriers within each stage 

Start-up Stage

Strategies

1. Availability of needs assessment

2. Intensive training

1. Incomplete needs assessment

2. Training challenges

3. Systems and technology incompatibility

Capability

1. Robust service capacity

2. Experience and Expertise

1. Limited service capacity

Relationships

1. Existing relationship

1. Lack of close relationship

2. Referral patterns limitation

Environment

1. Competition

2. Politics and contextual issues

Utilization Stage

Strategies

1. Intensive training

2. System and technology enhancement

3. Champions’ availability

4. Adequate staffing

5. Marketing plan

6. Adaptation of TeleED workflow

1. Training challenges

2. System and technology incompatibility

3. Champions’ absence

4. Staffing turnover

Capability

1. Robust service capacity

2. Experience and Expertise

1. Limited service capacity

2. Lack of utilization

Protocols

1. Well-defined workflow

1. Workflow flaws

2. Referral process limitation

Service Characteristics

1. Responsiveness

2. Care coordination

3. Assist with transfer

4. Meeting the needs

5. Video call benefits

1. Time-consuming process

Relationships

1. Close relationship

2. Enhancing existing relationship

1. Lack of buy-in

2. Locums not being on board

Financials

1. Contracting

2. Grant funding

3. Reimbursements

Environment

1. Lack of integration

2. Culture of transfer

3. Lack of awareness

Sustainment Stage

Strategies

1. Fit with needed service

2. Opportunities

3. Plan in place

1. Poor fit with needed service

Capability

1. Availability of multi-specialties

2. Availability of multiple services

1. Lack of multi-specialties

2. Lack of utilization

3. Lack of full-time ED physician

4. Lack of placement options

5. Poor attrition

Financials

1. Payment model

2. Contracting

3. Low cost of equipment

1. Payment model flaws

2. Reliance on grant funding

3. Not a money-maker

Accountability

1. Evaluation and quality improvement

2. Learning from the experience

1. Lack of evaluation measures

Relationships

1. Referral patterns

2. Network resources

Environment

1. Interfering politics and contextual issues