Efficiency gains are often promoted as a benefit of using technology. In home care, telehealth technology provides an opportunity for cost and clinical efficiency gains through the efficient use of monitoring technology in conjunction with in-person contact. However, most telehomecare programs use the technology in addition to the in-person visits. This study was a randomised controlled field study comparing the effects of a telehomecare intervention that substitutes for some standard home care services for patients following hospital discharge for heart failure with the effects of standard home care services alone. Contrary to study goals, findings revealed the patients in the technology group received more visits and a longer period in home care than the usual care group. As requested in the conference call for papers, the purpose of this paper is to describe the issues and barriers the team faced in implementing a substitution protocol and to propose solutions that may promote cost and clinical efficiency in future work.