The concept of technological frames of reference (TFR) has been used to uncover people’s sense making of information and communication technologies (ICT), in order to deepen the understanding of ICT use. But the role of the organization’s institutional context in the development of TFR has been overlooked, and most studies of TFR has been snapshots of frames. In order to contribute to the knowledge of ICT-use, the aim of the paper is to analyse how the interplay between institutional logic and TFR evolves over time. The aim will be pursued by the analysis of a case study of telemedicine use in a Swedish county during a 12 years period. It is concluded that the framing process moves between different levels of understanding guided by varying institutional logics. The understanding moves from an abstract level of what is best for the organization, to an understanding what is best for the group. Significant actors play a crucial role establishing dominant frames, or in re-framing the understanding the ICT. In this process institutional logics is drawn upon either to initially create a legitimacy for the ICT-use, or as an argument for non-use.