The SEHD component of the GSTP network expanded to connect three remote sites to SEHD headquarters at Waycross, and it was fully functional by 1995 (Adams and Grigsby 1995).
Further, under the GSTP network, the SEHD subnetwork was limited to only three sites, constraining its ability to expand linkage to all 24 offices within the district.
Once the network was fully functional, SEHD severed ties to the old GSTP network, but it maintained its relations to MCG by including it as a node in the new network.
By mid-2005, the network connected patients and staff at 16 of 24 sites in SEHD.
In 2003, SEHD received a second round of 3-year funding from OAT for further network expansion.
The new SEHD director considered the telehealth network a strategic asset and hired additional staff, including a new program manager.
The SEHD director decided to expand the network further.
The telehealth network at SEHD became sustainable, supported in part by federal funding, but increasingly paying for itself through new services and savings in travel expenses and time.
The process model (Figure 1) shows how interactions between key actors, institutional setting, and contextual dynamics shaped the telehealth innovation at SEHD.
B brought together local and external resources and set the stage for bringing specialty health services to SEHD.
A pediatric geneticist at MCG told us, "I started doing outreach clinics at SEHD in December 1984, and have continued ever since.
The SEHD telehealth initiative started as a GSTP pilot in 1993.