International Journal of Telemedicine and Applications communicated (primarily by electronic mail and secondarily by telephone call) with the selected individuals to make arrangements to provide informed consent forms and set up the interview in the clinic setting. Key informant interviews with Medical Directors of the sampled clinic sites occurred at each speciﬁc clinical site under study (see Appendix A). Once scheduled, the study coordinator then travelled to each study site and conducted the key informant interviews with the Medical Directors of the clinic sites. The format of the interview has been described in the key informant interview guide (see Appendix C). The intended format of the interview comprised ﬁrstly an initial general introduction focused on an assessment of clinical and administrative operations of the clinic (“tell me about your clinic”), with a keen intention to move towards a case-based scenario to focus on clinic-speciﬁc issues. The goal was to introduce a general case-based scenario and to direct provider thoughts regarding speciﬁc clinical and operational issues encountered when accessing specialty care services in the safety net. The intention was to then direct providers thoughts to discuss the potential use of telemedicine and to allow for an open-ended discuss ion on the key services for telemedicine that would beneﬁt the provider in their practice. The overall intent of the interview was to gauge clinic site-speciﬁc services for telemedicine and examples of how the use of infrastructural funds for telemedicine would beneﬁt the site. The semi-structured interviews were designed to take no more than 30 minutes. A sound recording of the conversation was made; however, no name or identifying information was used. 4.5. Ethnographic Analysis. Interviews were recorded with the explicit consent of participants. Recordings were then transcribed verbatim. Transcripts were examined with regard to domains of interest to include but not to be limited to relevant emergent sociocultural constructs. As is standard in qualitative research, an iterative process of analysis was used to examine and re-examine the facts and meanings contained in the data to develop successively more reﬁned ideas. Clinical and administrative operations of the clinic were assessed, with a keen intention to move towards a case- based scenario to focus on clinic-speciﬁc issues as it relates to accessing specialty care services within the safety net. The goal was to introduce a general case-based scenario and to direct provider thoughts regarding speciﬁc clinical and operational issues encountered when accessing specialty care services in the safety net. The intention was to then direct providers thoughts to discuss the potential use of telemedicine and to allow for an open-ended discussion on the key services for telemedicine that would beneﬁt the provider in their practice. The goal was to assess the priorities and identify key services for telemedicine that would beneﬁt from the use of infrastructural funds to enhance specialty care for uninsured and Medicaid patients in the San Francisco public health system. 3 Speciﬁcally, this was assessed by a process of analysis which involved ﬁrstly the parsing of descriptive data (text from observation and interview transcripts) according to themes as outlined above and secondly, the development of a set of taxonomic principles (a coding manual for signif- icant sociocultural concepts) and subsequent classiﬁcation (coding) of those themes and ﬁnally, the identiﬁcation of associations between themes. Firstly, the text data was read and formulated into 10 to 15 categories that encompass various domains of interest. Once the categories were standardized, all text data was coded. Once all of the textual data had been coded, text segments that referred to particular domains were retrieved. The extracted text segments were then reread and developed into more ﬁne-grained analytical categories to understand what underlied the concerns. Once contextual factors were identiﬁed, central themes were investigated further to see what links, if any, exist between themes. As a result of the ethnographic analyses of the provider interviews, salient themes revealed a set of services for telemedicine which would beneﬁt from the use of infrastruc- tural funds within the safety net. 4.6. Validity and Reliability in Ethnographic Research. Prob- lems of reliability and validity have been explored thoroughly by experimenters and other qualitative researchers in the literature. Reliability in ethnographic research is dependent on the resolution of both external and internal design problems [12]. While external reliability depends on whether researchers discover constructs in similar settings, internal reliability refers to the degree to which others would match them with data in the same way as did the original researcher. While reliability is concerned with the replication of scientiﬁc ﬁndings, validity is concerned with the accuracy. Establishing validity requires determining the extent to which conclusions eﬀectively represent empirical reality and assessing whether constructs devised by researchers represent or measure the categories of human experience that occur [12, 13]. While the internal validity refers to the extent to which scientiﬁc observations and measurements are authentic representa- tions of some reality, external validity addresses the degree to which such representations may be compared legitimately across groups. Although reliability and validity are common problems shared by all ethnographers and researchers, results of ethnographic research can often be regarded as unreliable and lacking validity and generalisability. The purpose of this study is not to question or assess the very method of inquiry but to enlist the deﬁned methods of inquiry in understanding the use of telemedicine to develop strategies in the context of the San Francisco Safety-net. 5. Ethical Considerations 5.1. Informed Consent Process. Participation entailed giving written permission to collect data in the interview settings. Participants in the key informant interviews were provided with a written consent form (see Appendix B) and were then