Access to care is a fundamental measure of the capacity of a health system to care for a population. Faced with severe constraints on access to specialty care, safety-net systems have been among the most fertile sites of innovation in the delivery of ambulatory specialty care. In 2005, the San Francisco Department of Public Health pioneered an electronic consultation system and tested the hypothesis in a large health system that management of some conditions could remain with the primary care physician (PCP) with remote support by the specialist. They demonstrated marked improvement in access to specialty care and improved communication between PCPs and specialists, with 72% of PCPs reporting that the system improved clinical care.1 In 2012, the Los Angeles County Department of Health Services—with over 3000 PCPs and a median specialty appointment wait time of 63 days, often exceeding 6 months—implemented a similar eConsult program.2