Telemedicine is not a simple technology but a context-dependent innovation implying significant process modifications. Despite the growing interest in telemedicine implementation, it still does not form part of the healthcare organizations' recurrent activities due to several obstacles. The neglect of process change is one of the renowned barriers. This work's originality lies in using the "process innovation" concept as an analytical tool to understand the telemedicine implementation issues from the process change perspective. The qualitative method is chosen based on five telemedicine acts through two case studies in France, a university hospital, and a network of expertise. Findings indicate that implementation requires context adaptation at the level of technology, culture, and strategy. The interaction of these determinants with change enablers and hinders creates the implementation paradigm. In conclusion, we should emphasize the implementation as a whole rather than distinct elements. Managers may prepare the context and integrate the enablers, but the main task is defining an implementation strategy benefiting the stakeholders. This work fills the literature gap in using the process innovation concept to analyze telemedicine implementation challenges and contributes to understanding the context adaptation. It also provides practical implications about the implementation conditions from the process change perspective.