This study examines the implementation of India’s national telemedicine service, e-Sanjeevani, through the perspectives of multiple stakeholders, focusing on enablers, barriers, and opportunities for technological advancement. Using a qualitative design, 18 key informant interviews were conducted with patients, Community Health Officers (CHOs), program coordinators, healthcare providers, and members of the development team. Thematic analysis revealed that national policy support, flexibility at the state level, free outpatient consultations, and training incentives for CHOs facilitated adoption. However, persistent systemic barriers include doctor shortages, uneven state-level utilization, long waiting times, poor digital connectivity, increased workload, lack of training, privacy concerns, and limited diagnostic integration. Developers noted challenges linked to customization demands and small technical teams, while program coordinators raised concerns about quota-driven distortions in service delivery. Despite these issues, e-Sanjeevani has notably expanded healthcare access in underserved areas, illustrating the potential of large-scale digital health platforms to reduce inequities. Sustaining this progress will require strengthening infrastructure, workforce capacity, and governance to address bottlenecks and ensure equitable delivery. Future development should also prioritize robust cybersecurity safeguards aligned with India’s data protection framework and stronger integration with laboratories and diagnostic systems to support continuity of care. The platform’s national reach, structured workflows, and large patient database create a foundation for AI-driven features such as automated triage, intelligent scheduling, decision support, multilingual tools, and predictive resource management— enhancements that could improve the efficiency, responsiveness, and resilience of India’s telehealth ecosystem.