For those who are considering the Free and Open Source OpenEMR solution, we have just completed an open source project with Advent
Consulting. The Advent team has provided insurance companies, HMOs, doctors and hospitals with implementations of sophisticated open source electronic medical record (EMR) system solutions. They also provided custom integration and support for voice over IP (using Asterisk) and SQL-ledger a FOSS accounting backend system. This provided us with a very efficient solution.