Introduction: Telemedicine has been shown to be a feasible and effective vehicle for health care delivery in many research studies, but its uptake has been slow and fragmented. The tele-endocrinology service in Princess Alexandra hospital in Brisbane, is one of instances of successful implementation of telemedicine clinic that has well-integrated into the routine care. The aim of this study was to identify the success factors and challenges for implementation and sustain of this service.
Method: Semi-structured interviews were conducted with the consultants, nurses, coordinator, and director of Diabetes and Endocrinology department at the Princess Alexandra hospital where the service is operating. Qualitative data were analyzed using thematic analysis technique.
 Results: Five major themes emerged: organizational-managerial factors, cultural and social factors, economic and financial factors and factors related to ethical considerations. The main challenges to the implementation of telemedicine clinic included resistance to change, distrust to the provider organization and uncertainty towards continuity of the service, and most important success factors were existing reliable infrastructure, executives support, and economic justification of the service as well as adopting a scalable service model, central coordination and proactive follow-up of patients.
Conclusion: Implementation of a telemedicine clinic and provision of remote treatment services are associated with numerous challenges, and various factors are involved in successful implementation and sustainability of such projects. The findings discussed in this paper can inform and inspire health care managers towards successful implementation of similar projects in Iran.