The Hawaii Medical Service Association will expand its online care offering with a doctor-to-doctor feature that will help primary care physicians consult with specialists.

HMSA was the first health plan insurer in the nation to use an online care system developed by Boston-based American Well, in January 2009 debuting the service that allows patients to connect with doctors 24 hours a day.

HMSA also will be the first health plan to adopt the provider-to-provider feature and said it hopes to institute the service by the end of the third quarter this year. Only Hawai'i specialists will be enlisted to consult with local doctors, HMSA said.

American Well announced the new offering at the World Health Care Congress in Washington, saying it will help bring specialists into primary care physicians' exam rooms and will help reduce the delay, inconvenience and costs associated with the traditional patient referral process.

The product will allow physicians "to render and coordinate much broader, timely and convenient care for their patient panel," said Ido Schoenberg, American Well chairman and chief executive officer.

"The primary care practice is now the gateway to the rest of the healthcare system, irrespective of its location."

HMSA promotes Online Care service as a way for late-night consultations when children were ill or when patients couldn't otherwise make it to doctor's offices. The program allows people to link up with doctors over the Internet or through telephone calls.

Information posted on HMSA's Web site said about 10,000 people have registered for the service with a little more than 20 percent of those using it to engage providers in live encounters on a variety of medical issues.

The service costs $10 for HMSA members during the first 10 minutes and $45 for people without HMSA coverage.

HMSA said that about 140 physicians statewide are available to take the patient queries. The most common patient is a woman age 26 to 45, who typically speaks to a family practice or internal medicine doctor about flu, colds, urinary tract infections or other infections.

About three-quarters of the calls come from O'ahu.

The new offering, however, may be popular with doctors on other islands where there are not as many specialists. A recent study by researchers at the University of Hawai'i's medical school found that the state's doctor shortage is worse on the Neighbor Islands than O'ahu.

It determined the state had more than 500 fewer physicians than it needs, with many of these being specialists.

American Well said the new offering should let physicians consult with specialists during patient visits. The doctors then could evaluate physical findings, lab and imaging results, eliminating redundant, time-consuming workups, the company said.