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                                                                   Exhibit 10.20


                        AMENDMENT TO EMPLOYMENT AGREEMENT


      This Amendment to that certain Employment Agreement (the "Amendment") by
and between ProxyMed, Inc. (the "Company") and Nancy J. Ham (the "Executive")
dated October 16, 2000 is entered into as of October 9, 2003 (the "Amendment
Date"). In consideration of the mutual covenants and agreements hereinafter set
forth, the parties agree as follows:

      WHEREAS, the Employment Agreement had an initial term of three (3) years;

      WHEREAS, the Company's Compensation Committee of the Board of Directors
has reviewed the 2003 performance goals applicable to Executive and has
determined that it is in the best interest of the Company and its shareholders
to allow the Employment Agreement to automatically renew for one (1) year; and

      WHEREAS, the Company and the Executive have agreed to amend that certain
Employment Agreement.

      NOW, THEREFORE, the parties agree as follows:

      1.    The Employment Agreement of the Executive was automatically renewed
            for a period of one (1) year from October 16, 2003 to October 15,
            2004 and shall be automatically extended from year to year
            thereafter unless otherwise terminated in accordance with the terms
            of the Employment Agreement.

      2.    The Executive's annual salary for the period commencing January 1,
            2004 to October 15, 2004 shall be $225,000.00, subject to any
            subsequent increases recommended by the Company's Compensation
            Committee and approved by the Company's Board of Directors in
            writing. Any such subsequent written document is hereby incorporated
            by reference and made a part of and shall amend the relevant terms
            of the Employment Agreement automatically.

      3.    Except as otherwise modified herein, all terms and conditions of the
            Executive's Employment Agreement shall remain in full force and
            effect. To the extent that a conflict shall exist as between the
            terms or conditions of the Employment Agreement and this Amendment,
            those of this Amendment shall prevail.

      4.    This Amendment may be executed in one or more counterparts, all of
            which shall be considered one and the same agreement and shall
            become effective when one or more counterparts have been signed by
            each of the parties and delivered to the other parties.


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      5.    This Amendment constitutes the entire agreement, and supersede all
            prior agreements and understandings, both written and oral, among
            the parties with respect to the transactions contemplated hereby,
            and (b) is not intended to confer upon any person other than the
            parties hereto any rights or remedies.

      IN WITNESS WHEREOF, each of the parties has executed this Amendment, in
the case of the Company by its duly authorized officer, as of the day and year
first above written.

PROXYMED, INC.                           EXECUTIVE:



By:  /s/ MICHAEL K. HOOVER               By: /s/ NANCY J. HAM
    ---------------------------------        ---------------------------------
    SIGNATURE                                SIGNATURE

Print Name: MICHAEL K. HOOVER            Print Name: NANCY J. HAM
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