Asynchronous pediatric specialty care: eConsults and eVisits as tools to improve access, demand management, and care coordination.

Timely access to pediatric subspecialty care remains a persistent challenge for health systems, families, primary care providers (PCPs), and specialists. Traditional referral pathways often require in-person visits for low acuity questions that can often be addressed through structured review of existing clinical information. Provider-to-provider electronic consults (eConsults) offer an asynchronous, electronic medical record-based model that enables PCPs to obtain pediatric specialty guidance without requiring an in-person subspecialty visit. Related asynchronous models, including patient-to-provider electronic visits (eVisits), may further expand low-acuity care capacity for low-acuity care. This article reviews eConsults and eVisits as demand-management strategies that improve access, reduce unnecessary referrals, support PCPs, preserve specialty capacity for higher-acuity patients, and promote more equitable specialty access. Drawing on published literature and implementation experience at Children's Hospital of Philadelphia (CHOP), this manuscript describes clinical applications, operational requirements, outcomes, implementation challenges, and future directions, including artificial intelligence-augmented guidance and evaluation of clinical outcomes beyond healthcare utilization.