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Healthcare technology investments must be borne by charity, government subsidy, or patient reimbursement. Such investments can be expensive and require partnerships of public and private institutions. This paper explores the relationship between technology sustainability and healthcare governance of multi-institutional technology partnerships. A technology is assumed to be sustainable if the initial investment is paid and the operating costs are covered from one or more of these sources. Entirely possible is need for new governance forms in order to manage the initial and ongoing partner expectations. Can partnerships that initially rely on charity and government subsidy transform into self-sustaining or profitable operations? This paper incorporates findings from a business study of the Brazos Valley Telehealth Partnership (BVTP) that provides telemedicine infrastructure for a group of healthcare institutions who serve a seven county rural area. This paper explores the impact of technology sustainability on partnership governance. The findings are based on experiences gained during the formation and operation of the BVTP. The paper considers the valuation of network externalities. The paper posits that impact of technology adoption on organizational continuity on governance forms. The paper suggests incremental and continuous changes are best addressed by individual organizations or partnerships. For disruptive changes, new organizational forms are needed to isolate the disruptive impacts on organizations and processes. The paper concludes by advocating practical suggestions and further research.