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Open Source software is competing successfully in many areas. The commercial sector is recognizing the benefits offered by Open Source development methods that lead to high quality software. Can these benefits be realized in specialized domains where expertise is rare? This study examined discussion forums of an Open Source project in a particular specialized application domain - electronic medical records - to see how development roles are carried out, and by whom. We found through a qualitative analysis that the core developers in this system include doctors and clinicians who also use the product. We also found that the size of the community associated with the project is an order of magnitude smaller than predicted, yet still maintains a high degree of responsiveness to issues raised by users. The implication is that a few experts and a small core of dedicated programmers can achieve success using an Open Source approach in a specialized domain.