Currently telehealth is being offered as an innovative solution to austerity, staffing issues and problems accessing care in Canada's rural communities. Despite the current enthusiasm for telehealth in provincial and federal policy documents, many of these promises have not been realized. The Labrador region is a large and sparsely populated area that was vested with a federal "Smart Community" project to increase the region's technological capacity, making it one of the most connected locales in the country. While telehealth was a key component of the SmartLabrador plan, there has been limited uptake of newly available technologies for the purposes of mediating distance in health care. My work critically examines the factors surrounding this lack of uptake, and takes the work of Harold Innis as a starting point when analyzing the breakdown of time and space in Labrador. Focused around qualitative field research conducted in Labrador in 2003, I explore spatialization, structuration and work practice as they relate to telehealth use and non-use in the region. I review federal and provincial telehealth policy to provide a macro context for the study, which I then link to meso and micro levels of analysis in organization structures and situated work practice. I examine telehealth in the user context from the health care provider perspective. This reveals several constraints that have limited the usage of new technologies for health communication in Labrador. The user context must be considered in the design of telehealth programs and policy if the desired outcomes for telehealth are to be realized. The barriers to telehealth use are not simply technical, but relate to issues of privacy, culture and trust. I discuss these and other barriers with a focus on the needs of the Labrador community. © 2007 Springer Science+Business Media B.V.
