v30#4 The eBook Package Subscription Model: Analysis of Publication Years and Usage

by | Oct 10, 2018 | 0 comments


by Jie Li  (Assistant Director for Collection Management, University of South Alabama, Biomedical Library)  

and Geneva B. Staggs  (Director and Senior Librarian, University of South Alabama, Biomedical Library)  


For more than two decades, health science libraries have been building their electronic collections of books and journals.  “Shifting from print to digital collections” is identified as the second highest trend in health science librarianship.1  For journals, the shift from print to electronic collecting has been nearly completed.  The shift from print books to eBooks appears to be occurring at a more measured pace.2  Books are becoming more popular in academic libraries and especially in health science libraries and usage of eBooks is exponentially higher than the print alternative for health science library users.3, 4  However, there are problems dealing with eBooks.  In 2008, Meg White discussed the availability, discoverability, usability problems of eBooks.5  Today these problems still exist.  Problems with eBooks include not all being available in electronic format and many core clinical titles simply cannot be purchased as perpetual licenses.  No one vendor can supply all that libraries want. Each package includes titles that have not been used by library users.6  In addition, some highly regarded health titles are not available electronically to libraries, even though individuals may purchase the electronic format.  Because of the nature of eBook packages, there is no single package that is searchable by users as easily as journal article searching of databases. Discovery tools are far from perfect for locating eBook chapters or topics across all packages.  Because of the difficulties of searching eBooks, libraries use various creative ways for eBook searching. Czechowski and Tannery discussed a library developed search tool at the University of Pittsburgh for eBook searching.7  Li, et. al. discussed multiple access point approaches for eBook access.8  

Traditionally, journals are sold using a subscription model as there is new content added several times each year in new issues and volumes and print books are sold for one-time charge.  Even though new editions of major medical eBooks do not appear each year in package, they are not always sold with perpetual licenses. Since the advent of electronic journals and books, many book publishers have followed the publication model of journals, selling eBooks on a subscription model and grouping books into packages.  Some publishers do not allow libraries to purchase individual titles, especially the core clinical titles. Instead, they group titles into packages and libraries must subscribe to eBook packages, because libraries may need only the prestigious titles in these packages. The main eBook packages in medicine include AccessMedicine from McGraw-Hill, ClinicalKey from Elsevier, LWW Health Library from Ovid and MedOne Education from Thieme as well as specialty packages, such as surgery or pediatrics from these publishers.

A Study of Popular Packages

In this study, the authors examined the publication years of eBooks included in some popular eBook packages, as well as the usage from the University of South Alabama Biomedical Library subscribed packages in 2017.  The publication year analysis of eBooks included a major eBook package and a specialty eBook  bundle from each publisher or vendor. The aggregations included in the analysis were AssessMedicine (AM) and AccessSurgery (AS) from McGraw-Hill, ClinicalKey (CK) from Elsevier, LWW Health Library Premium Basic Sciences Collection (HL-BS), LWW Health Library Clerkship & Clinical Rotations Collection (HL-Clerkship) and LWW Health Library Surgery Collection (HL-Surgery) from Ovid.  Publication years of eBooks were examined.  Three-year intervals of the publication dates of new editions were analyzed to determine whether the selected eBooks remained current.  Three years (2014-2016) of usage of eBooks by individual titles and by package were analyzed to determine cost-effectiveness.

The publication years have been arranged in three year spans to determine the overall currency.  The results are shown in Table 1.

Average intervals of new edition publication: AM 3.39, AS 5.08, CK 7.23, HL-BS 4.61, HL-Clerkship 4.62 and HL-Surgery 5.21.  Publication year varies. eBooks published in 2014-2017 are as high as 60% in one package to 25% in another. If these eBooks could be made available with perpetual licenses to libraries, there would not be a need to pay for annual subscriptions.

Not all eBooks in packages are being used.  Carrico, et. al. found 49.71% of eBooks they analyzed unused.  Usage is better in medicine with 63% of eBooks ‘circulating’ in the University of Florida study.9  The University of South Alabama Biomedical Library subscribes to AccessMedicine, AccessSurgery and ClinicalKey.  Three years (2014-2016) of eBook usage in these packages were examined.  Table 2 shows eBook usage in these databases.

The results are mixed and disclose both high- and low-use titles.  The data show, in two packages, eBook usage for some is very heavy and for others only adequate.  However, in one package, the majority of eBooks are hardly used, even though there are heavily used individual core clinical titles included in the package.


Based on the eBook usage study done at the University of South Alabama Biomedical Library, and surveying literature on the topic, it can be concluded that the needs for eBooks in medical libraries have not changed, but the current pricing and packaging models present challenges to medical libraries trying to serve their users.  The advantage of eBook packages is that they bring leading medical resources into one integrated package. Many eBook titles are specifically geared toward the curricular and clinical needs of health science library users. Furthermore, many of the titles in the packages are textbooks for health science students, especially for medical students and for resident training.  Many medical libraries are researching emerging and alternate avenues for providing textbook access to their users, including LibGuides and open educational resources (OER). Aligning them in this way makes them more discoverable at point of need, expanding access to “free-to-you” textbooks to students. A disadvantage of the current package model is that selected (but desired) titles are only available through the packages.  For instance, libraries cannot license individual eBook titles from the above mentioned packages. Bundled titles have one price and cannot be purchased separately. Package model pricing eliminates the ability for libraries to select only eBook titles needed by their library users. Committing resources to large packages limits the library’s ability to purchase other materials. The librarian’s ability to select more suitable titles for the collection is not available under this pricing model.  eBooks are currently needed for the same reasons Kubilius stated in 2005:  curriculum support, clinical and reference, basic science, examination review, and non-specialty books like consumer health, alternative medicine and health policy.10  The library’s need to collect eBooks to cover all these topics would be affordable if tight budgets were not already consumed by the need to pay high cost for eBook packages that contain core titles that cannot be purchased individually.

This article is based in part on research compiled for a 2017 Medical Library Association conference poster entitled “eBook Package Subscription Model: Benefits for Library or Publishing Industry?”  The purpose of the research was to examine usage of individual titles in eBook packages commonly licensed or acquired by health sciences libraries for their users.  


  1.  Jeannette Murphy, “International Trends in Health Science Librarianship Part 17: A Comparison of Health Science Libraries with Academic and Research Libraries,” Health Information & Libraries Journal, 32 no.4 (December 2015:326-331.
  2.  Roger C. Schonfeld, and Matthew P. Long, Ithaka S+R US Library Survey 2013 (March 2014).
  3.  Jie Li, “Is It Cost-effective to Purchase Print Books When the Equivalent E-book Is Available?” Journal of Hospital Librarianship, 16 no. 1 (January-March 2016):40-48.
  4.  Deborah M. Taylor, “Comparison of Selected e-Books and Equivalent Print Books: Have Handheld Portable Devices Increased Use in Three Aggregated Resources?” Journal of Electronic Resources in Medical Libraries, 10 no. 1 (January-March 2013):11-24.
  5.  Meg White, “eBooks in Health Sciences Circa 2008 — What Have We Got for Our Journey Now?” Against the Grain, 20 no. 5 (November 2008):26-30.
  6.  Leslie Czechowski, “Problems with e-books: suggestions for publishers,” Journal of the Medical Library Association, 99 no. 3 (July 2011):181-182.
  7.  Leslie Czechowski, and Nancy Tannery, “eBook Access Via a Library-Developed Full-Text Search Tool: A Five-year Reflection,” Against the Grain, 23 no. 6 (December 2011-January 2012):42, 44.
  8.  Jie Li, Justin C. Robertson, Andrea L. Wright, and Robert M. Britton, “E-Book Management: A Multiple Access Points Approach,” Journal of Electronic Resources in Medical Libraries, 9 no. 2 (April-June 2012):103-113.
  9.  Steven B. Carrico, Tara T. Cataldo, Cecilia Botero, and Trey Shelton, “What Cost and Usage Data Reveals About E-Book Acquisitions,” Library Resources & Technical Services, 59 no. 3 (July 2015):102-111.
  10.  Ramune Kubilius, “eBooks in Health Sciences: Trends and Challenges,” Against the Grain, 17 no. 1 (February 2005):36-40.

Appendix: Available Health Science eBook Packages

This is a list of popular of health science eBook packages, by no means comprehensive.

McGraw-Hill Medical Collections




AccessEmergency Medicine








Case Files Collection

Clinical Sports Medicine Collection

F.A. Davis PT Collection

McGraw-Hill Medical eBooks

McGraw-Hill USMLE

LWW Health Library Collections
from Ovid

Anatomical Sciences

Basic Sciences

Integrated Basic Sciences

Premium Basic Sciences

Clerkship & Clinical Rotations

Osteopathic Medicine




Orthopaedic Surgery

Emergency Medicine

Board Reviews

Advanced Practice Nursing

Cornerstone Pharmaceutical Sciences

Clinical Pharmacy

Integrated Pharmacy

Premium Pharmacy



ClinicalKey Nursing

MedOne Collections from Thieme

MedOne Education

MedOne Neurosurgery

MedOne Plastic Surgery

MedOne Radiology

MedOne Spine

MedOne Otolaryngology  

MedOne Clinical Collections

AAP Collection

AAP Neonatal Resuscitation



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