Open Medicine (http://www.openmedicine.ca) 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 (OpenOffic...