The Foundation helped create the Open Knowledge Commons (OKC) in order to have more community building efforts in our open digitization initiatives and to catalyze new large?scale collaborations among libraries. This request is the first major digitization effort from OKC, and it involves creating an open digital library focusing on the history of medicine as a theme and drawing on the participation of five major institutions: the National Library of Medicine (NML); the Francis A. Countway Library of Medicine at Harvard Medical School; the Harvey Cushing/John Hay Whitney Medical Library at Yale University; the Augustus C. Long Health Sciences Library at Columbia University; and the New York Public Library. There are enthusiastic letters of endorsement from all five institutions, which include three of the leading collections in the world (NML, Harvard, and Yale). Following an initial phase of digitization of public domain monographs, they would also create a de?duplication database to prevent redundancy of efforts, a tool based on that used by the successful Biodiversity Heritage Library (BHL). The BHL is a model for this theme?based approach to scanning. The history of medicine is a very rich discipline intellectually that cuts across many fields. It is estimated that the entire field numbers about 1,500,000 volumes, of which half (750,000) are pamphlets, including dissertations, one third (500,000) are serial volumes, and the remaining sixth (250,000) are monographs. This effort would digitize 30,000 monographs or just over 10% of the existing collection. This effort would be a collaborative venture taking into account the scholarly needs and sensitivities of the academic and library communities which have not always felt well-served by existing digitization efforts. Given the new economic environment as well as the Google juggernaut, we need to be more selective and strategic about our digitization efforts and to try to build wider collaboration and coordination among interested users that will also benefit the general public.