4 reminded of the consent process at the time of the interview (see Appendix C). 5.2. Subject Conﬁdentiality. Key informant interviews with providers were voice-recorded but stripped of any names or other identifying information in the transcriptions; however, even though participants were informed of the risk that their responses could be shared with the Hospital leadership team at SFGH for the ultimate goal of improving care and services oﬀered, this was not required. Although the tapes and transcriptions have been kept in a locked cabinet on premises at San Francisco General Hospital, Building 20, Suite 2300, and San Francisco, Calif, once this research article is published, they will be destroyed. 5.3. Risks and Beneﬁts Analysis. There were few, if any, risks to participants in study. Participation could have resulted in a loss of privacy. The interviews were voice-recorded for the purposes of creating a computer transcription for a word processing program. Care was taken to eliminate names from the transcripts; however, responses from the key informant interviews could have been shared with the leadership team at San Francisco General Hospital with the ultimate goal of improving care and services oﬀered; however was not required. The sound recording was stored in a locked ﬁle. Each person in this study had their own code number so that no one other than me and the co- investigators of the study knew who was in my notes. The key to the code of names was kept in a separate locked ﬁle and is to be destroyed following completion and publication of the study. The survey data was stripped of any personal identiﬁers. The potential beneﬁts to the participants were the opportunity to participate in research and contribute to the scientiﬁc community by providing greater understanding in low resource healthcare settings and assist in further enhancements and developments of the telemedicine program for the San Francisco safety net. 5.4. Payments to Participants. Participants in the key infor- mant interviews did not receive any payments, nor any form of remuneration for their time. They were informed of this during the informed consent process as detailed in the C HR (Committee on Human Research) application. 5.5. Cost to Subjects. There were no costs to participants in this study other than their time for participating in the key informant interviews. 6. Study Population The study population for the key informant interviews were twenty participants to include the Medical Directors of 14 Community-Oriented Primary Care Clinics (COPC) and the 6 UCSF medical specialty division clinics at San Francisco General Hospital and Trauma Center (SFGH). The study population for this study, although small in number, was suﬃcient to assure the validity and reliability of this ethnographic research since they were identiﬁed as International Journal of Telemedicine and Applications key stakeholders for telemedicine, input from whom was deﬁned as being vitally important to the implementation of key services for telemedicine in the safety net. The list of these study sites is shown in Appendix A. The study population included those that were invited to participate in the study. 6.1. Participant Inclusion Criteria. To be included in the study, a study participant had to have been a Medical Director/Clinical Chief aﬃliated with COPC clinics and/or the UCSF medical specialty divisions at SFGH. Participants must have also voluntarily given written informed consent to discuss telemedicine in their practice for the delivery of specialty care to patients. 6.2. Participant Exclusion Criteria. Participants were ineligi- ble to join the study if they had not voluntarily given written informed consent to participate in the interview. Informed consent was obtained at two points during the study, once during the recruitment process (Appendix B) either through email or phone or again at the time of the interview. 7. Measurement Tools The interview guide for the key informant interviews was created with assistance from the Global Health Sciences research methods class materials and qualita- tive/ethnography analysis experts at UCSF, Global Health Sciences Division at 50 Beale Street. The goal of the interview guide was to elicit as much information as possible regarding clinical and administrative operations of the clinic site in general, 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 and 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. A copy of the interview guide has been included in Appendix C. 8. Results and Discussion A total of 11 qualitative interviews were conducted with primary and specialty care providers from eleven diﬀerent clinics throughout the safety net. Out of the 11 providers, 8 were Medical Directors of the COPC and 3 were Chiefs of UCSF Medical Specialty clinics. Repeated attempts to contact the remaining 6 PCP and 3 Specialists were accomplished in order to include them in the study; however none were included. Even though some of the providers noted interest in participation and arranged for a time at their convenience for the interview, last minute schedule changes as well as cancellations resulted in nonparticipation. The purposes of these interviews were to gain an in- depth understanding of the current process of patient referral to specialty care services within the safety net and to improve the delivery of these types of services to patients using telemedicine. Key informant interviews engaged with