Background:
Countries, including India, were quick to adopt telemedicine for delivering primary care in response to the widespread disruptions in routine healthcare delivery due to COVID-19 pandemic. This expeditious adoption was critical and the challenges faced during this exigency could guide the design and delivery of future telemedicine applications for primary care delivery.

Methods:
With an aim to identify challenges in delivering primary care via telemedicine technology in Indian context a scoping review was conducted using popular medical database (PUBMED) and largest database of peer-reviewed literature (SCOPUS). Drawing from the systems approach in healthcare delivery, the review findings challenges are summarized at four levels, patient, provider, healthcare organizations, and, policy.

Results:
Out of the 247 search results, 13 articles met our inclusion criteria. This review highlighted that telemedicine facilitated continuity of care during COVID-19 but not without challenges. Low levels of education and computer literacy along with language barrier posed challenges at patient level. Providers were challenged due to limited skills in using systems, and had concerns related to efficiency and effectiveness of remote consultations, legal liabilities, and unethical behavior of patients. The healthcare delivery system faced challenges in ensuring an integrated care as there was lack of integration with diagnostics, pharmacies, and other departments. The current policy landscape falls short in addressing data privacy and security concerns, unethical behavior by patient, or provider, and regulating prescriptions of psychotropic drugs.

Conclusion:
Telemedicine has the potential to improve primary healthcare delivery and address health system challenges even beyond COVID-19. The reviewed telemedicine applications in India mirrors the existing fragmented healthcare delivery system. There is a need to acknowledge and factor-in the inter-connectedness of health system elements and organize health system elements facilitating an integrated care approach via telemedicine thereby ensuring an effective and efficient healthcare delivery via telemedicine.