Since 1998, over 1300 telemedicine consultations have been provided to 12 schools in Kansas City. Despite the success of the programme, effective utilization of services has not occurred at all sites. We used a focus group and survey methods to investigate barriers to and catalysts for service adoption. The results showed that the school nurses strongly supported the programme. They valued its ability to provide health-care for the children and they welcomed their enhanced role. However, technical complexities and difficulties in obtaining parental consent were found to impede adoption. The nurses also expressed frustration with school personnel who had a poor understanding of their role in general as well as that of the telemedicine service. A new state reimbursement policy may promote greater understanding and provide a financial incentive for schools to adopt the telemedicine service.