In this study we provide a fine-grained description of the micro-processes of innovation through a qualitative study of the implementation of telemedicine innovation in a healthcare organization. Our qualitative analysis uses a mix of participant interviews, observation techniques and archival data sources. We use the concept of translation to describe the movement of ideas and practices through social interrelationships. Our results suggest that the implementation of innovation involving changes in extant institutional practices is a result of a translation during which actors assess not only their specific role within a given institutional practice but also how their actions influence the broad outcome. Our results bring to the fore the role that interactions between organizational actors and institutional practices play in the implementation of innovation. Consistent with the translation perspective, our results suggest that the implementation of innovation is mainly an organizational change process facilitated by a concurrence of meaning or the lack of it lack among organizational actors. Our study provides new evidence on the institutional practices that are created, maintained, modified as well as disrupted during the implementation of externally developed innovation.