Background <p>Telemedicine is increasingly recognized as a key innovation for strengthening primary healthcare in low-and middle-income countries. In India, Community Health Officers (CHOs) are the end-users of assisted telemedicine platform at Ayushman Arogya Mandirs. While evidence on patient perspectives is growing, this study focuses on telemedicine usefulness, satisfaction, and system-level barriers perceived by the end-users of the assisted telemedicine platform.</p> Methods <p>A cross-sectional mixed-methods study was conducted in two Indian states, Jharkhand and Tripura. A quantitative survey of 550 CHOs was administered using the Indian Telemedicine Assessment Scale. To contextualize findings, 16 qualitative in-depth interviews were conducted with purposively sampled CHOs, focusing on barriers, facilitators, and lived experiences of telemedicine delivery.</p> Results <p>Survey respondents were predominantly female (75.6%) and under 30 years of age (59.3%). On a scale of 1–5, CHOs rated telemedicine platform highly for learnability (Mean = 4.2) and ease of use (Mean = 3.95). Overall performance was rated at 3.91. Qualitative interviews highlighted persistent barriers, notably inconsistent doctor availability, long teleconsultation wait times, medicine stock-outs, and poor network connectivity. Despite these constraints, CHOs emphasized key facilitators, including reduced patient travel and out-of-pocket expenditure, and improved access to qualified physicians.</p> Conclusion <p>CHOs perceive telemedicine as a valuable tool for delivering primary healthcare, with strong potential to enhance access and equity in rural India. However, persistent system-level barriers limit satisfaction and utility. Embedding telemedicine within broader health system strengthening through reliable doctor’s availability, robust medicine supply, digital infrastructure, and capacity-building of CHOs is critical to realizing its transformative potential.</p>