Telemedicine holds great promise for increased access to specialty care services for safety net clinic patients. However, the adoption of these technologies is not a seamless transition for clinicians working in resource-poor settings. Previous research has analyzed workflow issues that arise in primary care settings when adopting telehealth tools but has not examined the unique workflow challenges facing specialists who provide assessments to safety net clinics. Findings are presented from a case study that employed qualitative methodologies as part of an assessment of a teleretinal screening program in Los Angeles urban safety net clinics. The program utilizes external ophthalmologists to perform retinal readings. The case study provides insights into how difficulties that arise in reader workflow are resolved and identifies unique factors requiring consideration when highly trained specialists perform teleretinal readings. The discussion outlines important issues to address when developing telehealth workflow protocols for the safety net, specifically, and their broader applicability in telemedicine.