The Pacific Island Health Care Project (PIHCP) has in the past provided definitive care at the Tripler Army Medical Center (TAMC) for nearly 3000 patients. To contain costs, increase access, and provide consultative and referral services to physicians in the Pacific Basin, a web-based network was established in 1997. Four sites in the Western Pacific were provided with a desktop computer, digital still and video cameras, flatbed scanners, and printers. Consultations with supporting imagery are submitted to TAMC where the consults are data-based and dynamically posted on a secure web server. TAMC consultants triage and comment on the cases and the educational significance. Unnecessary or inappropriate referrals are returned with instructions for local care. Cases are formatted to allow rapid response, image review, consultant/provider interaction, and peer review. More than 180 consults have been submitted from the island nations electronically (30 September 1998) and initial experience indicates that the Internet can be easily used as an inexpensive store and forward consultation format. There has been an overwhelming enthusiasm for this project by all participants and for the first time since the inception of the PIHCP, funding was available during the entire fiscal year, with tens of thousands of dollars saved.