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Health Sciences eBooks in 2021: Availability, Challenges, and Trends

by | Sep 30, 2021 | 0 comments


By Ramune K. Kubilius, MALS  (Collection Development / Special Projects Librarian, Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine) 

and Tim Butzen-Cahill, MLIS  (General Manager, Doody Enterprises, Inc.) 

Against the Grain v33#4

The health sciences eBook landscape has been examined periodically over the past 20 years.  eBooks continue to play a central role in today’s health sciences library collections, so it’s worth assessing factors that affect eBook acquisition, such as market availability.  At each library, internal requests and usage patterns prioritize collection development decisions, while core title lists are tools for expanding collection breadth — to help identify gaps, new editions, and new subject areas.  Though core title lists may not address all of a library’s collection needs, criteria-based and regularly maintained core lists can provide samples of titles for collection studies.  For this brief review, we used a present-day health sciences list, Doody’s Core Titles (DCT), to examine the state of health sciences eBooks and their associated landscape. 


In 2002, Linda Walton and Ramune Kubilius reported that 99 percent of 120 academic health sciences libraries’ websites they examined showed the availability of Web-based textbooks.  However, their survey of a popular core list of the time (the Brandon/Hill list, described below) revealed that online format was only available for 19 percent of the titles recommended in that list (Kubilius and Walton).  Online title availability is not the only driver of usage, as Ella Hu’s 2019 case study about commonly licensed eBook packages showed: basic medical science eBook usage is highest, while usage of eBooks in various specialties varies.

The 2001 definition of “eBook” used by Rick Lugg and Ruth Fischer — “…monographic body of content, intended to be published and accessed electronically” — will be broadened for this brief review.  The term will encompass monographs, textbooks, reference books, handbooks, and examination review books provided in electronic format for those involved in education, clinical care, and/or research. 

Doody’s Core Titles

For forty years (1965 to 2004), the Brandon/Hill lists were “selected lists” of important print book and journal titles recommended for small medical and hospital libraries, and libraries of all sizes relied on the lists to make informed acquisition decisions (Hill and Stickell).  Doody’s Core Titles, first published in 2004 after it was announced that the Brandon/Hill lists would no longer be published, is an annual refereed list of books in the health sciences (Doody’s, “History”).  While DCT continues and expands the legacy of the Brandon/Hill lists, it differs in that it does not include journals. 

DCT includes books in 121 specialty areas broadly covering all aspects of medicine, nursing, allied health, basic sciences, and affiliated disciplines.  It is available for purchase and is incorporated into some book vendor sites.  Each edition includes titles selected and rated through a collaborative process between librarian selectors and content specialists (Doody’s, “Core Title Selection Process”).

The 2,246 titles selected for the 2021 edition of DCT comprise more than three and a half times the size of the Brandon/Hill list used for the 2002 study.  To establish the availability of core titles as eBooks, the authors analyzed data from DCT’s eBook discoverability program, an opt-in feature for publishers and aggregators to provide DCT users links to source eBooks for institutional licensing or as part of a collection (Doody’s, “eBook Aggregator Partners”).  At review time, e-versions of 1,847 DCT titles (82%) were available for online institutional licensing, more than four times the percentage of core titles available as eBooks (19%) in the 2002 study.  The substantial increase is partially due to the growing number of eBook licensing platforms:  eight aggregators were identified in the 2002 study, while DCT 2021 includes data from 36 licensing platforms from 17 aggregators.  

Continuity exists within the industry: six of the eight 2002 study aggregators still host DCT titles in 2021 (with some corporate and product name changes):  LWW, Ovid, McGraw Hill, Elsevier (MD Consult in 2002), Teton Data Systems, and Wiley.  While in 2002 health sciences eBook aggregators were also core title publishers, in 2021 the greatest selection of eBooks are hosted on platforms of third-party library service providers and book distributors.  EBSCO’s GOBI includes 1,611 (87%) of the 2021 core title eBooks, and ProQuest’s Ebook Central includes 1,233 (67%).  Rittenhouse’s R2 Digital Library includes 404 (22%), while Ovid provides access to 353 (19%), the largest offering of the six 2002 study aggregators that host DCT 2021 titles.  

It isn’t only library service providers that have moved into offering eBook content.  Society publishers also offer institutional licensing packages, including the American Academy of Pediatrics (Pediatric Care Online) and the American Psychiatric Association (Psychiatry Online).  Commercial publishers have expanded their offerings.  McGraw Hill, for instance, now offers more than a dozen subject-specific subscription collection options, many of which include DCT 2021 titles.


Since 2008, DCT users have had access to eBook availability information, though it remains optional for publishers and aggregators to participate.  This information is neutral, does not weigh into the DCT selection process, and likely does not influence publisher and aggregator eBook models or practices.  Notably, 399 DCT 2021 titles (18%) are not currently marked as available in eBook format.  The titles are published by 76 different publishers (roughly 61% of publishers with DCT 2021 titles).  Some of the titles may not be available as eBooks.  If they are, information may not be provided by DCT online discoverability partners, or availability may be on platforms that are not traditionally licensed by libraries, such as learning management or clinical health information systems.  This represents a significant gap in title availability — on publishers’ proprietary platforms and in what they offer through aggregators — which poses challenges for libraries wishing to provide online access to core titles.  This also suggests opportunities for aggregators to seek arrangements with more partner publishers in order to diversify their institutional eBook licensing portfolios.  Admittedly, though, expanded availability of health sciences eBooks from third-party aggregators still may not include titles critical to a specific library’s needs.  Also, local practices, policies, and procedures determine choices and preferred routes for licensing eBooks. 

Health sciences libraries’ collection expenditures have increasingly grown more diversified.  Subscriptions to journals, a traditional scholarly output in the health sciences, continue to predominate, and database licenses remain a recurring annual expense.  Libraries are also increasingly called upon to acquire and manage nontraditional online resources (Shultz and Berryman).  Still, eBooks continue to be authored, edited, published, and used.  Budgeting for eBooks can be challenging, since each acquisition model may represent different itemizations:  one-time purchases, recurring subscriptions, and annual platform fees.  As the DCT 2021 analysis illustrates, commercial and society publishers vary in eBook packaging and institutional licensing models.  Libraries experience constraints of pre-packaged, often pricey collections containing unwanted titles, and limited a la carte title options.  Challenges are not limited to librarians — end users experience many pain points when accessing and navigating digital information as well (Laera et. al.).  When curriculum-related eBooks are only available on platforms targeting individuals, will students want (or be able) to pay out of pocket, or will libraries offer to manage access to these platforms that have no (traditional) institutional licensing business models? 

In 2001, Sherry Thompson observed eBook challenges, “hurdles (that) include everything from licensing issues, potential access problems, internal and external customer training issues, negotiation disagreements between parties to solving misunderstandings about contracts.”  In 2021, progress can be seen in greater eBook content availability and improved usage reporting standards, but other continuing challenges, mentioned by Thompson and illustrated in this review, can place libraries in untenable positions, caught between institutional expectations and industry business models.  


The events of 2020/2021 brought changes that will likely have ripple effects.  Publishers offered free trials and expanded access during the COVID-19 pandemic, and libraries needed to manage access to and discovery of this content.  Closed libraries “paid a second time” for online access to inaccessible print books they already held.  They responded to national and world events by expanding eBook collections into new areas, including diversity (DEI, multiculturalism, anti-racism), foreign medical language learning, the history of medicine (pandemics), global health, and graphic medicine.  Publishers and third-party providers, including Doody’s, responded to new needs by creating various “special topics” collections and lists (Doody Enterprises).

Examples of innovation in recent years include eBook enhancements with multimedia, review banks, personalization, and functionality.  Consortial and institutional eBook initiatives often include STM (scientific, technical, and medical) publishers and content.  For example, in March 2021, member discussions began for FY 2022 crowdfunding of an eBook program in Illinois that would build on funding received from the Secretary of State/Illinois State Library (CARLI), and an Open Access book agreement was announced between University of California Berkeley and Springer Nature (Springer Nature).  Local initiatives involving both Open Access books and Open Educational Resources (OER) are gaining a foothold in academic health sciences institutions, requiring technology or development support, more than simply traditional library collection funding.  

There is no doubt that many changes have occurred in the health sciences eBooks landscape over the past twenty years and more recently.  One does not need a crystal ball to predict that more evolution lies ahead.  


The authors appreciate the helpful comments provided by their colleagues — Bart Davis, Joelen Pastva, and Dan Doody. 


CARLI.  2021.  “CARLI News May 26, 2021.”  Last modified May 26, 2021.  https://www.carli.illinois.edu/carli-news-may-26-2021 

Doody Enterprises. n.d.  “Doody Special Topics Lists.”  Accessed May 20, 2021.  http://corp.doody.com/doodys-special-topics-lists/ 

Doody’s Core Titles, n.d.  “History.”  Accessed May 20, 2021.  http://www.doody.com/DCT/Content/DCTHistory.asp 

Doody’s Core Titles, n.d.  “Core Title Selection Process.”  Accessed May 20, 2021.  http://www.doody.com/DCT/Content/DCTProcess.asp 

Doody’s Core Titles. n.d.  “eBook Aggregator Partners.”  Accessed May 20, 2021.  http://www.doody.com/DCT/Content/DCTAggregators.asp 

Hill, Dorothy R. and Henry N. Stickell. n.d.  “A History of the Brandon/Hill Selected Lists.”  Accessed May 20, 2021.  https://web.archive.org/web/20080808135219/http:/www.mssm.edu/library/brandon-hill/history.shtml

Hu, Ella.  2020.  “Ebooks in an Academic Medical Library: Is Our Ebook Collection Aligned with the Medical Programs?”  Doody’s Core Titles, June 9, 2020.  https://www.doody.com/dct/PublicFeaturedArticle.asp?SiteContentID=350 

Kubilius, Ramune and Linda Walton.  2002.  “E-Books/Web-Based Medical Textbooks.”  Handout presented at Health Sciences Lively Lunch at the Charleston Conference: Issues in Book and Serial Acquisition.  Charleston, SC, November 1, 2002.  https://doi.org/10.18131/g3-rbk4-sj05

Laera, Elizabeth, Karen Gutzman, Angela Spencer, Charlotte Beyer, Saskia Bolore, John Gallagher, Sean Pidgeon, and Ryan Rodriguez.  2021.  “Why are they not accessing it? User barriers to clinical information access.”  Journal of the Medical Library Association 109, no. 1 (January): 126-132.  https://doi.org/10.5195/jmla.2021.1051 

Lugg, Rick and Ruth Fischer.  2001.  “The Host with the Most: eBook Distribution to Libraries.”  Against the Grain 13 no. 6 (December): 35-40.  https://doi.org/10.7771/2380-176X.3646 

Shultz, Mary and Donna R. Berryman.  2020.  “Collection practices for nontraditional online resources among academic health sciences libraries” Journal of the Medical Library Association 108, no. 2 (April): 253-261.  https://doi.org/10.5195/jmla.2020.791 

Springer Nature.  2021.  “Springer Nature and UC Berkeley Library sign new open access book partnership.”  Springer Nature Group, March 23, 2021.  https://group.springernature.com/gp/group/media/press-releases/new-open-access-book-partnership-with-uc-berkeley-library/18993926 

Thompson, Sherry.  2001.  “Health Science eContent Distribution: The Challenges and Opportunities.”  Against the Grain 13, no. 6, (December): 34-5.  https://doi.org/10.7771/2380-176X.3645   


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