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Introduction: Telemedicine is a field that deals with monitoring and caring for patients who are physically apart from the caregivers, so they cannot communicate without technological means. The use of telemedicine has been recognized by a number of official organizations worldwide. This article reviews a unique service, "pediatrician online", provided by Clalit HMO, through Medtrix Ltd, with Schneider Children's Hospital specialists' supervision. With this service, parents can receive medical consultation from pediatricians beyond community clinic hours. The service is provided by telephone, computer or a mobile application, and when possible video calls are made., Aims: To describe and analyze four years of telemedicine experience of the "pediatrician online" service., Methods: A retrospective study was performed including analysis of all consultation calls conducted between November 2009 (the beginning of the project) and December 2013. Every call to the service was recorded and documented. Furthermore, analysis was conducted of follow-up calls to 4% of the applicants in order to monitor medical outcome and satisfaction., Results: During the first four years approximately half a million consultation calls were provided. The average time from referral to obtaining medical advice was eight minutes. The duration of the consultation was four and a half minutes on average. Most of the calls were related to young children under 4 years (74%), dealing with common pediatric problems - fever (23%), respiratory complaints (17%), and gastrointestinal problems (12%). One-third of the applicants intended to go to the emergency department before they called the service, but only about one-sixth were referred at the end of the consultation. Among those referred, only about 60% actually went to the emergency department. The use of video-calls has been increasing, and reached an average of 30% of the applications. Satisfaction with the service was very high according to surveys, scoring 9.8 out of ten. Eighty-two percent of patients sampled reported medical improvement on the next day., Conclusions: There is a very high demand for consulting pediatricians beyond clinic hours. The use of telemedicine, as provided by the "pediatrician online" service, addresses this need safely and effectively with high patient satisfaction. Discussion: The use of telemedicine is expected to expand. In order to ensure its proper use while recognizing the capabilities and limitations, controlled studies should be conducted, exploring the outcome of different approaches in various situations.