Explaining success and failure of IT initiatives is a subject with long tradition in the information system field. However, users’ drivers and motivation of the adoption of voluntary open-ended technology has been understudied. It is not clear why users would choose to adopt a new voluntary technology and how and why its use options and possibility unfold. In this paper these questions are examined through the analysis of a longitudinal case study (1994-2012) of telemedicine adoption in a northern Swedish county. The findings reveal that it is not sufficient to make an open voluntary technology available for its users, or passively demand them to use the technology. Successful use would occur through a continuous interplay between users’ technology mental models and their organisational setting and work practices. When in contradiction with the latter, users would not consider the system and hence its use could fade away. Institutional entrepreneurs who have the ability to imagine new and different possibilities and encourage organisational members to experiment and explore possible use and benefit from the technology could influence the initial mental model.