Open Medicine ( is an electronic open access, peer-reviewed general medical journal that started publication in April 2007. The editors of Open Medicine have been exploring the use of Free and Open Source Software (FOSS) in constructing an efficient and sustainable publishing model that can be adopted by other journals. The goal of using FOSS is to minimize scarce financial resources and maximize return to the community by way of software code and high quality articles. Using information collected through archived documents and interviews with key editorial and technical staff responsible for journal development, this paper reports on the incorporation of FOSS into the production workflow of Open Medicine. We discuss the different types of software used; how they interface; why they were chosen; and the successes and challenges associated with using FOSS rather than proprietary software. These include the flagship FOSS office and graphics packages (OpenOffice, The GIMP, Inkscape), the content management system Drupal to run our Open Medicine Blog, wiki software MediaWiki to communicate and archive our weekly editorial and operational meeting agenda, minutes and other documents that the team can collectively edit, Scribus for automated layout and VOIP software Skype and OpenWengo to communicate. All software can be run on any of the main operating systems, including the free and open source GNU/Linux Operating system. Journal management is provided by Open Journal Systems, developed by the Public Knowledge Project ( OJS assists with every stage of the refereed publishing process, from submissions, assignment of peer reviewers, through to online publication and indexing. The Public Knowledge Project has also recently developed Lemon8-XML ( lemon8), which automates the conversion of text document formats to XML, enabling structured markup of content for automated searching and indexing. As XML is required for inclusion in PubMed Central, this integrated, semi-automated processing of manuscripts is a key ingredient for biomedical publishing, and Lemon8-XML has significant resource implications for the many journals where XML conversion is currently done manually or with proprietary software. Conversion to XML and the use of Scribus has allowed semi-automated production of HTML and PDF documents for online publication, representing another significant resource saving. Extensive use of free and open source software by Open Medicine serves as a unique case study for the feasibility of FOSS use for all journals in scholarly publishing. It also demonstrates how innovative use of this software adds to a more sustainable publishing model that is replicable worldwide.