Exceptions to anti Physician-self-referral laws are being proposed by CMS. The laws ban physicians from referring patients to entities in which they have a financial stake like laboratories. Originally designed to prevent abuses, “They were never intended to stand in the way of bringing effective electronic health care to patients…These new proposals would allow hospitals and certain health care organizations to furnish hardware, software, and related training services to physicians for e-prescribing and electronic health records, particularly when the support involves systems that are �interoperable� and thus can exchange information effectively and securely among health care providers…” Could this be good or bad for Free and Open Source Electronic Medical Records? Is there potential for abuse by creating monocultures of proprietary hardware and software through hospitals dictating proprietary solutions? Could this make the problem of fragmentation even worse?