The paper makes a case for the use of sociology of translation as a way of integrating the classical rational and stepwise view of innovation, showcasing its capacity to produce accounts of innovation that are process oriented, sensitive to contextual conditions, and attentive to its political, conflictual and institutional aspects. It does so by utilizing the approach to study the establishment and mainstreaming of cardiac telecare in northern Italy. Building on the results of a three-year longitudinal study, the paper describes the process through which this innovative approach carved a space within the existing texture of medical practices by enrolling in successive waves a range of allies and support. The detailed narration brings to the fore some crucial aspects of the local processes of negotiation and struggle and, more generally, the work and effort that goes into the making of any innovation. The paper concludes that this way of studying and narrating innovation is particularly capable of bringing back time, effort and politics into the account of the innovation process.