- The Journal of Medical Internet Research (JMIR) was the first open access journal in health informatics, established in 1999. It pioneered an innovative open access publishing model and business model. - JMIR has achieved success as a leading scholarly journal in its field, demonstrating that sustainable open access publishing is possible with creativity and a lean model. It has contributed innovations like article-level metrics and open peer review. - Open access was a key factor in JMIR's impact and visibility beyond a small readership, advancing knowledge dissemination and uptake in health informatics.