My opinion is that open source works because the benefits are all for
users, not vendors.

For Linux and many current open source products, the users and the
developers are one and the same.

I think this is unrealistic in health care because there are so few
developers who would use a medical records system (for example).

The model I see emerging is that users are exchanging open source
products between themselves and contracting developers to build and
enhance them.  I believe this model is sustainable.

-Brian

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