Electronic consultation and referral (eCR) systems have increased access to care, optimized efficiency, improved PCP capacity for complex decision-making, and promoted dialogue between PCPs and subspecialists. However, to date, eCR systems are limited to communication in the provider-to- provider dyad; the process is largely invisible to the patient. While the eCR model of specialty care delivery is spreading throughout the United States, no known studies have examined patient involvement with this model of care delivery. In response to this gap in knowledge, CEPC is partnering with the Center for Innovation in Access and Quality to conduct an observational study that will assess the level of understanding of patients, families, and caregivers in engaging in an electronic consultation model of specialty care delivery. This study will also explore their interest in participating in this process of exchange and potential components of a patient-centered electronic consultation and referral eCR system at San Francisco General Hospital.