Rationale The introduction of home telecare in healthcare organizations has shown mixed results in practice. The aim of this study is to arrive at a set of key factors that can be used in further implementation of video communication. We argue that key factors are mainly found in the organizational climate for home telecare implementation, the characteristics of the implementation strategy and the available technology. Methods Interviews were conducted in three care organizations with 27 respondents of different levels within and outside the organization. Implementation determinants, based on earlier research, were used as a categorization framework for the interviews. Results We found that most prominent factors influencing implementation outcomes relate to the stability of the technical and the external environment and the alignment of organization, goals and implementation strategy. Conclusion Because of the experimental nature of implementing video communication, attention to telecare influencers has been inconsistent and disorganized but it is becoming increasingly important. According to the respondents, a champion-led roll-out is imperative for implementation in order to advance to the next stage in home telecare and to organize services for substitution of care.