The COVID-19 pandemic has seen a surge in development of Open Source Hardware, especially open source ventilators. Many of these open source ventilator projects have adopted an open-when-finished model due to legitimate legal and liability concerns. This, however, has led to a proliferation of projects with teams across the world independently designing over a hundred mutually incompatible ventilators, representing a huge amount of duplicated effort. A functioning design is necessary but not sufficient for a project to help patients. The device must be taken through regulatory approval by a manufacturer that understands why design decisions were taken. In this article we argue that the open design process developed for Open Source Software can be used for Open Source Hardware. This process not only allows remote teams to work together improving a single design, it also provides the rich history of design decisions that manufacturers need to take the device through regulatory approval.