A rapidly growing area within the field of telephone medicine is the use of centralized telephone triage systems to help in the after-hours coverage of pediatric practices. This paper describes a 10-year experience with a pediatric telecommunications program within the 302,000-member Health Centers Division of Harvard Pilgrim Health Care. Telephone volume averages 3,000 calls per month, and over 175,000 telephone calls have been received since the program began. This article highlights the linkage to the primary care physician, the enhancement of service by the automated medical record system, and the application of the telecommunications program to resident teaching. The literature review focuses on the rationale for structured telecommunications programs, including improved quality of care, reduction of medicolegal risk, and the potential for reimbursement of services.