Organizing eBooks

I feel like I am beating a dead horse when I mention the topic of ebooks, but it is one of those topics that I just can’t put to rest.  The reason I can’t put it to rest is because ebooks are wanted by our users but they are pain in the neck for librarians, users, and probably publishers too.  Users want downloadable books and unless a library subscribes to something like UnboundMedicine (which can be very costly) there aren’t a lot of options.  Most of our ebook providers still provide ebooks only via the web (you need a Internet connection either via WiFi or cell tower) to view them and they certainly aren’t downloadable. In addition to these physical barriers of ebooks, just finding them can be a challenge. 


Finding ebooks is like wandering through a maze but without the cool pattern.

Finding an ebook is like wandering through a maze but without the cool pattern.  In order to find an ebook medical library patrons must navigate the catalog or the web page or know the silo their specific title is hosted.  They run into more dead ends and switchbacks that it is frustrating and deafeating. Why?

The catalog is dead (but that is another blog post).  Users just really don’t search it.  They search Google or they will slog through the library website looking for ebooks to magically be listed.  We have so many ebooks from different vendor packages (McGraw Hill Access databases, StatRef, Ovid, Wiley, Springer, MDConsult, etc.) and it is pretty much impossible to create and maintain an accurate web list of the ebooks.We used to keep up  a web page on a title and subject basis  but with hundreds of titles (thousands once you add in OhioLink) the web list was impossible to maintain.  We also used to list our ebooks providers. We had a web page detailing that ebooks could be found at the following sites (then lsited all of the vendors like AccessMedicine, Ovid, StatRefe, etc.)   That wan’t helpful.  Users have no clue where each title is housed, so they don’t know to “just click on AccessMedicine to view the online version of Harrison’s.”  The big web page with links to AccessMedicine, AccessSurgery, OvidBooks, StatRef, Wiley, MDConsult, Safari Tech Books, was not helpful. 

Unfortunately we learned that we were thinking too much like a librarian when we tried to direct people to our ebooks.  What do I mean by this?  If you aren’t a cataloger think back to library school cataloging, and if you are a cataloger I appologize for my crude cataloging example.  We librarians have been ingrained to provide as many discover points to a resource that we can.  When we catalog a book we do it to the exact specific subjects (thus making a general subject search difficult) and we add all sorts of added titles, authors, subjects, etc. to make it more findable.  The idea is sound for cataloging, but it is VERY bad for web design and discoverability.  

We recently conducted a user survey of our website.  We knew it needed to be redesigned but we wanted to know how our users were trying to find things in order to create a better site.  The one thing that was stated repeatedly was that users did NOT want multiple ways for finding things.  They wanted one straight shot way and that was it.  As librarians we were brought up to try and think of all the ways people might try to find something and make it findable in those ways.  We designed our web pages that way.  It turns out our users viewed the multiple ways just like navigating a giant maze.  The added paths did not aid in discoverablity they just served as switchbacks causing user navigation confusion.

Because ebooks are in different silos and our users have abandoned the catalog, it is difficult to provide one single easy way of searching and accessing anything beyond a very small collection of ebooks.  EBSCO A-Z does now keep track of ebooks.  But that is such a new feature (released in 2011 or 2012) it is still really too new to be effective.  Batch uploading doesn’t keep author or subject changes/additions.  Information from the publishers is sometimes missing making the author search a crap shoot. We have consolidated the various ways users can find our ebooks down to two ways; search the catalog or search EBSCO A-Z.  Neither method is exactly ideal, somethings are in the catalog that aren’t in A-Z and somethings are in A-Z that aren’t in the catalog.  It isn’t the best method for finding ebooks, but it is an improvement over the multitude of ways we provided.  Still because I know my users are looking for ONE way to find ebooks, I am always trying to find out how other libraries best to do that. 

So how do patrons find your ebooks?  What methods are working?  What isn’t working?  Do they use your catalog?  If so how did you get them to use it and how do you keep up with the ebook changes?  Let me know your thoughts because I can’t be the only one banging my head against a wall when looking at ebook discoverablity.

ClinicalKey Brief Review

Over on I wrote a brief review on ClinicalKey.  The post is direct more towards doctors rather than librarians but it is worth a read through for librarians. 

Over here I thought I would include a few things that librarians might find interesting about ClinicalKey.

I have to say that the front page of ClinicalKey where it has two large squares “For Institutions” and “For Individuals” kind of confusing.  While testing the product we had a couple of librarians who kept clicking the “For Institutions” square to try and search the product.  But they were confused because they kept getting into information about ClinicalKey for Institutions.  They thought they were supposed to click the “For Insitutions” button to search because they were in an institution.  We had to explain to them you just type in the box and hit the search button.  As a a librarian who often fields questions from users, I have a feeling this will be confusing for our users.  I am not sure which blue box they will click on but the boxes are just so large and so close to the search box it implies there are different accounts for different users.  I understand Elsevier wants to market ClinicalKey to both groups, perhaps they can find a less confusing design to do that.

Access to PDFs currently is a two step process for users.  Recently (just after I submit my write up to iMedicalApps) Elsevier required an additional login to access the PDFs.  Basically users must create a personal login and password to access the PDFs even while on the insitutional account.  If you have read my blog or followed me on Twitter for any amount of time you will know that requiring additional logins to common (not customized) content is a barrier to usage.  Patrons understand if they want to save articles, images, or customize the content they have to create a personal login.  Patrons do NOT understand the need to create a personal login to access regular content just to read. 

They are often dissatisfied with this additional login and they do one if not several of these things:

  1. Don’t use it. They quit, they don’t bother trying to get the PDF.
  2. Yell at the library because “we don’t have the PDFs” because it is asking for additional login.
  3. Get confused and try using every other login under the sun that they know.
  4. Repeatedly call the library for the special login (which we don’t have because it is a personal login).

The big thing is though, users won’t use it.  Plain and simple.  Plenty of librarians have usage data to back this statement up.  Creating a login to view the PDFs is a barrier. 

Now it is also a barrier for copyright piracy, which is one of the main reasons Elsevier has instituted the PDF personal login requirement.  They are also using the login information to generate usage statistics. They said that this information could help us understand usage but I am unsure as to what usage statistics we as librarians really care about that are the personal login level.  Really all I care about is overall usage, resource usage (which books & journals are being used), etc. 

There have been some librarians who have expressed their displeasure over the PDF personal login requirement.  As a result Elsevier has said they are investigating other alternatives.  I look forward to them making alternative adjustments so that they can eliminate the personal login requirement.

Librarians are going to have really look at their needs and what they want.  ClincalKey is a very nice (almost) all inclusive Elsevier product.  Subscribers get 900 book titles, almost all of the Elsevier journals (Nursing is not in ClinicalKey) and a ton of videos and images from the Elsevier books.  However as I mentioned in the iMedicalApps article, ClinicalKey is a bit like trying to take a drink of water from fire hydrant, there is that much Elsevier information.  As a result, institutions barely using MDConsult or find MDConsult to a lot of information, might be ovewhelmed by not only the price but amount of content.  Institutions looking to subscribe to ClinicalKey really should have ways to manage the amount of information because it would be silly or downright negligent to not have an link resolver to handle finding all of the ejournals, an established method to handle finding the ebooks (whether it is your catalog, home grown system, or a link resolver that does ebooks).  If you don’t have an easy way to manage the fire hydrant of information then you shouldn’t be getting ClinicalKey in its present form. 

Other things that I think need to be addressed are downloading (for appropriate use) of ebooks and how they are dealing with the FirstConsult app. 

The writing is on the wall, the horse has left the stable, use whatever metaphor you want but users are now expecting to download ebooks to their iPads to read offline.  This needs to be build into the system.  FirstConsult isn’t the only product that hasn’t done this, McGraw Hill’s Access databases, Ovid, etc. have not figured out how to create a ebook product that will check out books for download to users.  I am not sure how they do that while still keeping it within the larger product like ClinicalKey or AccessMedicine, but this is something that must be addressed now because users expect this. 

I realize ClinicalKey is too new to really have an idea as to what they are doing regarding apps.  But there should be some sort of statement or direction as to whether the FirstConsult app will continue on as is, or whether they will change things and make it more of a ClinicalKey app with FirstConsult.  Like the downloadable ebook market this is an area where our uses have specific expectations. 

Those of you who have tried or bought ClinicalKey what are your thoughts?  Those of you who don’t have it and don’t plan to get it what are your thoughts and reasons? Write a comment either here or on iMedicalApps
Thoughts on extra login for PDF and Librarian’s thoughts on ClinicalKey.

Free Webinar on AMA Titles

As you all know AMA moved their online platform to Silverchair recently.  Now you have the opportunity to attend a free webinar to “Discover the New JAMA Network Online”  The webinar is August 2, 2012, 10 am CST/11 am EDT. 

The webinar will have representatives from the AMA and Silverchair to answer your questions about the recent transition to Silverchair’s SCM6 platform and demonstrate the latest enhancements to, including:

  • How to use the Administrator Dashboard
  • How to access usage reports
  • How to maximize search results

Speakers include Matt Herron, Vida Damijonaitis, and Betsy Solaro from the AMA and Kate Nikkel and Joy Moore from Silverchair.

Register at it is free.

More on the Open Access Debate

An interesting article was recently published in US News and World Report about traditional publishing, open access publishing, libraries, and money. “Is the Academic PUblishing Industry on the Verge of Disruption?” looks at the various problems and potentials of open access publishing and it impact on traditional publishing, libraries, funding of research, etc.

The open access debate is very contentious and quite frankly I don’t know enough about both sides of the issue to make an intelligent comment for or against either side.  My only comment is that if this author’s information is true and 80% of publishers’ income is from libraries then something needs to be done quickly because we (libraries) cannot continue buying.  As Jean Shipman mentions in the Comments, library budgets have been shrinking. When will we get to a tipping point when the publishing houses fail to make 30-40% profits because 80% of the market can’t afford them?  We are very close.  I believe I will see this happen in my career.  What becomes of it, I don’t know.

Unfortunately this article is just on open access publishing, but the problem is bigger than that.  Many libraries subscribe to non-traditional resources such as DynaMed, UpToDate, FirstConsult, VisualDx, Primal Pictures, etc. that are not journals.  They are point of care guides, image systems, etc. that are also very expensive to subscribe to and continue to increase in price.  They are in our budget and we can’t afford them just like we can’t afford the online journals.

It is a mess.

Free eBooks Webinar

ALA TechSource has a free webinar, “Introducing the Book as an iPad App” on July 23, 2012 at 2:00pm est. 

Brief description from ALA TechSource:

iPads are everywhere. Some publishers are experimenting with a new kind of book, published as an app. These books are distinct from the mostly-text ebooks you might read with the Kindle or Nook apps. Drawing from all the functionality of the iPad platform, creators may extend the book, presenting a new immersive experience for readers. As hybrids mixing elements of film, videogames, and social media in with the text traditional to the book, this new kind of book challenges the notion of what a book is. For librarians, they offer new opportunities in evaluation, selection, and services.

The webinar will probably be more geared toward public library and possibly academic libraries but it is free and might be worth attending to see how ebooks are evolving for libraries.  I think public libraries have a better handle on ebooks than medical libraries so perhaps there are some things that we should be looking at and aware of for our situation. 

If you are interested you need to register.  Go to:

My Loser Boyfriend: eBooks

As much as I love ebooks and technology, they are like a crummy loser boyfriend.  Full of ups and downs that take you on a roller coaster of emotions only leaving you to love them one minute and hate them the next.  Just like that loser boyfriend they have money issues and sometimes I find myself humming Joan Jett, “I Hate Myself For Loving You,” when dealing with them.


  • They are available whenever, wherever, and can’t be stolen, lost, or damaged.
  • Using ebooks I can provide information to patrons across the hospital at the time of need and they don’t have to come to the library.
  • Many ebooks can be updated more often than traditional print books.


  • The distribution of medical ebooks is STILL behind the public library model (and while the public library model isn’t that spectactular it runs circles around what we have). 
  • Publishers who require an ADDITIONAL logins if you are using a smart phone.  It is confusing to patrons, they don’t understand why they are being asked for a password when they are on the hospital network.  In this instance they don’t think of their phone any differently than a lap top. (ahem MDConsult/Elseveier)
  • Many ebooks are stuck in publisher silos, can’t be searched effectively.  No NORMAL person knows to go directly to StatRef to search, then AccessMedicine, then MDConsult, etc.  They just know they want a book on a topic and they want to type in the topic somewhere and be presented with a list of ALL the ebooks that has their topic.  Some librarians say…ah use the catalog.  Ptthbbb, ever try searching for a chapter topic or something else within the content of the book in the catalog?  It sucks.


  • Few companies have a few book titles that can be downloaded to a mobile device but they are way too expensive because we have to BUY the book and they don’t have a circulating model plan (ala public libraries).   Large publisher’s with books we need and pay lots of money for can’t be downloaded to any mobile device, they are web enabled…yeah patrons love hearing that. 
  • I get the idea that an online book is more expensive than in print because it can be viewed by many, but if one online title is a 1/3 of my book budget, I can’t buy it no matter how much I want to have it online.
  • We all are either scraping by on less budget or a flat budget while just trying to keep current library resources that keep getting more expensive. I have no flexibility to “try” your new product.  I don’t care if it is cool and it addresses a need, I can’t afford it.  The price might be reasonable or it might be whack-a-doodle but I still can’t afford it without dropping something.  My wish list is a mile long and it isn’t getting shorter with items that are reasonable (as well as whack-a-doodle) pricing. 

Right now we are all searching for the Mr. Right of ebooks.  Part of the difficulty is that Mr. Right for me might be Mr. Wrong for somebody else.  But our potential boyfriends (the publishers) need to step it up considerably if they want to be Mr. Right for any library because it seems many of us are unhappy and currently settling for Mr. Right Now.  

This what my patrons want (therefore this what I want):

  • eBook platforms that work on lap tops AND are downloadable to a mobile device (not web enabled to a mobile device).
    • We need the core chunk of titles that we are CURRENTLY buying from you, don’t increase the price so that one dinky little title is $2000 online and a established plain ol’ text (not a even a reference book) is $15,000.  That my friends, is whack-a-doodle pricing. We don’t buy online books like that now, making it “downloadable” at that price is not going to change our mind or our budget.
      • For example AccessMedicine, MDConsult, Ovid get your ebook platforms that we are already buying downloadable….now!
  • We are very open to the circulation model of ebooks.  Public libraries are doing it and our patrons seem to understand that concept. This is a nice alternative to buying the title and should be cheaper than buying the title.  Think of it as renting.
    • We need a collection of decent titles. Not a pittance of specialty books.  We need/want the Harrison’s, Hurst’s, DeVita’s, etc.  We need real titles, don’t shove your Big Toe Science book in there, unless we are podiatrists we don’t want them and won’t buy them.
  • Eliminate the artificial barriers for access.  We do a VERY good job of maintaining proper access to our online resources (becasue your license agreements require us).  We know better than you do who our patrons are and when to cut them off, so let us do our jobs and stop putting up extra logins while people are on network or proxied.  If our patrons get confused, they don’t use, if they don’t use we don’t buy. Plain and simple, extra loggins affect our usage stats (negatively) and we don’t buy or drop your stuff if our usage stats go down.  Remember we have wish list a mile long waiting for weakness in a product. 

Some day I hope that I am able to look back at ebooks like I do at my old loser boyfriends; a phase that I had to go through in order to meet Mr. Right.

Unauthorized Copies of Medical Texts on Apple Apps Store

I am on vacation this week so I have also been taking a bit of electronic vacation as well with the blog. But I ran across a post earlier this morning and thought….”Wow I have to blog about this!”

The post is on, “Are unauthorized copies of popular medical textbooks being sold in Apple App Store?” While reviewing “Human Anatomy Pro for iPad” by YoDevApps LLC, Tom Lewis noticed striking similarities between the Human Anatomy app and the Gray’s Anatomy for Student App/textbook. Yet, there was no mention of this in the original iTunes description and upon further examination, Tom noted that all the images and words were direct copies of the original text of Gray’s.

Tom emailed (June 10, 2012) YoDevApps LLC for explannation of the “similarities,” and basically Evans Ben (YoDevApps), in a poorly worded and spelled email, told Tom there are similarities to Gray’s as well as other texts because he consulted the text when creating his app.
Yet this is not limited to Human Anatomy Pro and Gray’s. Tom discovered there were several titles that appeared to have a lot in common with well established medical texts. They are:

  • Illustrated Medical Dictionary (Similar to Dorland’s illustrated Medical Dictionary)
  • Principles of Internal Medicine (Similar to Harrisons Principles of Internal Medicine)
  • Clinical Medicine (Similar to Clinical Medicine by Kumar and Clark)
  • Principles of Anatomy and Physiology (Similar to Essentials of Anatomy and Physiology)

On the iMedicalApps site Tom provides screen captures of images from the YoDevApps iTunes page and compares them to the other textbooks.  When making the comparisons, Tom used both printed editions of books (Kumar and Clark) and other ebook editions (Harrison’s via Inkling).  The images are identical.

Obviously as Tom indicates, these apps raise a lot of questions about proper licensing and distribution of copyrighted material.  Since the content appears to be heavily borrowed, it also makes it extremely difficult to trust the developer on content accuracy which is essential for medical apps.

iMedicalApps recently contacted publishers (of the original texts) and Apple regarding situation and will update their article when they have a response from those involved. As of 6/12/2012 Elsevier has responded and is “initiating action”.

Not only is this whole thing interesting from a copyright standpoint, but it reminds us that we must be careful regarding medical apps.  Any developer can throw something up on the App Store and have it look reliable.

Are Publishers Too Old To Design/Create Effective eBooks?

Wolters Kluwer tweeted a link about a middle school class creating the top selling enhanced ebook on iTunes. The book,  “Creatures, Plants and More! A Kid’s Guide to Northwest Florida,” is interactive and contains pictures, videos and text related to the wildlife found in Northwest Florida.  It was published by a seventh grade class at Woodlawn Beach Middle school, based on a student assignment to create multimedia content around the local gulf-coast wildlife.

Now the book is free, so I am sure that helps keep it at the top of the best “seller” list.  One could argue the press surrounding the creation of an ibook by middle schoolers helps drive the “buys” as well.  However, the book was just published April 26, 2012 and according to a May 1st  article (earliest report on the ebook I could find) on the Woodlawn Beach Middle School’s web page, the book was already the top ranking free book. So, while the press coverage might add to the popularity, the book itself started out strong.

Why is this important, especially on a blog about medical librarianship?  

Maybe I got up on a different side of the bed today, but this report got me thinking about the design of ebooks and whether publishers are just too old, to “get it.”  Are the powers that be and structure within publishing  too steeped in the traditional concept of a paper book to really understand the idea of an interactive ebook?  to further explain this let me draw upon my grade school experiences with computers. (Yes I can remember back that far.)

When I was a kid (2nd or 3rd grade) everyone seemed to be rushing to get computers in school and I remember an old room converted to a computer lab stuffed with Apple IIe’s.  Time in the computer lab was supposed to be important, but since the whole grade school had to share 10 computers, we didn’t visit the lab very often.  The only time I remember visiting the computer lab was for math class, specifically plotting graph equations on the computer.  We would spend the whole math hour inputting coordinates into the computer and at the end, if we did it right, we were “treated” to a green line or triangle.  Booooorring.  I got nothing out of that.  I actually dreaded computer lab time.

In grade school we never used the computers for anything other than that section in the math curriculum.  Yet everyone spoke about technology in the classroom, using computers in education, and teachers were asked to teach with computers.  However the problem was the teachers were using old traditional concepts and marrying them to computers.  They really didn’t adapt the lessons or concepts at all.  The tool of the computer was little more than complicated graphing paper.  They were forcing a square peg into a round hole but not realizing they were even doing that. 

Now the computer has been around for long time and we now have the Internet.  Many teachers today grew up with computers (or at least remember sitting in front of those old Apple II’s).  Their minds no longer think of the computer as a technology, it is a part of their life, a tool for other things.  It is integrated better into the curriculum because it is already integrated into their (and their students) lives.  It is now as common as other things in the classroom like reference books, smartboards (no more banging chalk out of erasers), desks, etc. 

The interactive ebook is the Apple IIe, we don’t know how to create or use it effectively.  The vast majority of us have been programmed with the linear thinking of traditional books.  Many of us talk about converting medical texts into ebooks but we (including publishers) think of the book as a linear progression; start, middle, end.  We throw in movies, pictures and sound but those are positioned in a linear way; within chapters.  Often the ebook is the paper book with multimedia and perhaps added chapters.  But it is usually pretty straight forward.  It is the paper juiced up on steroids, but it is still the paper.

So while the middle schooler’s ebook is still more in line with traditional books it was created only as an electronic product therefore it is free of some of the contraints from already printed version.  Perhaps as tablet devices evolve and people grow up with them and begin to think of them as an everyday thing, our ebooks will begin to evolve beyond the print model.  My 5 yr old or my 1 yr old will be thinking of something totally different regarding an ebook when they are adults.  They will be the ones to see how to publish and distribute content that was once in paper.

How Do I Generate Interest in QR Codes?

This project was to increase awareness our patron’s awareness of our e-book collection and I am worried I am going to going to become Sisyphus in the process.

E-books are hard for patrons to know about.  We still have a large group of users who peruse the stacks for books on a topic. 

Possible Solution:
Put the subject list of e-books within eyesight of those who browse the shelves.  Create a brightly colored message to be displayed on the shelves informing people of our ebooks and how to access them.

Ideal outcome:
Users will see the QR code and scan them with their smartphone to view a list of ebooks within that subject.  We are using to create the codes and track their usage. Users without smartphones will see the note and check the catalog for ebooks. 

Used bright yellow paper and old unbound journal holders.



Made multiple notices for each subject area depending on the size of print collection (area it spans on the shelves).



Distributed the notices through out the stacks within each subject area and spaced for maximum viewing opportunity.

QRs In Stacks

We haven’t invested anything into this project other bright yellow paper and my time.  We used the many unbound journal holders that we had left over from our print journal days to post the yellow paper and as place holder in the stacks.  Even the QR code generator and tracker is free.  The only thing that really wasn’t free was our e-books but we bought them long ago before QR codes were known to geeks. 

So while we haven’t invested anything in the project. We have a vested interest that our e-books get more usage.  This project is just another way to drive attention to them. 

Still, I am plagued by a persistent little voice in my head asking whether people will even bother to scan these codes.  Because according to the CNN Tech article, Why QR Codes Aren’t Catching On, “many people don’t understand what QR codes are or what to do with them.”  The article cites a study by Archival which found that while “80% of students owned a smartphone and had previously seen a QR code, only about 20% were able to successfully scan the example QR code they were shown. Furthermore, about 75% said they were unlikely to scan a QR code in the future.”  Even if people know what a QR code is and know how to scan it this Market Plan post says, Consumers Still Don’t Know What to do With QR Codes

I really want this project to work, but these articles suggest I have an uphill battle.  It is going to take a lot of promoting and educating to get this QR code thing moving. 

I have begun to post signs through out the library and strategically next to QR codes in the stacks (see the yellow code below the sign) promoting our e-books and the QR codes.



I finally got all of the yellow QR code signs in the stacks and the advertising signs up on Friday.  It is Monday and while I know I have a long way to go before I know if this project is boom or bust, I need to come up with some more educational and promotional ideas to get it off to the best possible start.  So I am asking you all in the library world to throw me some suggestions via your comments.  The suggestions won’t only help me, they will help others who are thinking of doing the same thing.

Harrison’s Through Inkling vs. AccessMedicine

The iMedicalApps team compared Harrison’s Principles of Internal Medicine on Inkling vs. AccessMedicine.  I feel I am at a bit of a conflict of interest here.  I have recently begun to work with iMedicalApps to write some posts (I am currently working on a post right now) and I agreed to moderate the Medical Librarian’s Corner of their Medical Apps Forum.

My problem is that I see at least one error in the review, another area where the author needed to be clearer in their evaluation, omissions regarding updates, and a slight bias toward student use.  As a result it makes it difficult for me to read the comparison without talking back to the computer.  Now I don’t have an iPad (saving up for an iPad 3 when they come out) and I don’t have a subscription to Inkling, but I have worked with Harrison’s Online through AccessMedicine extensively so I am extremely familiar with it.  Since I don’t have Inkling’s Harrion’s I can’t do a comparison of the two products, but I feel the need to point out the error in the review and provide some criticisms about the review itself.

While I may be struggling with how to do this appropriately given my new relationship with iMedicalApps, I don’t have any conflict of interest with AccessMedicine, McGraw Hill or any of the Access databases.  In fact I have recently been kind of critical of them for having difficult mobile access policies (require personal login even while on campus) that do more to hinder the use of their ebooks. 

Update 2/22/12 Ooops…I am wrong, I do have a conflict of interest with McGraw Hill that I should report.  I am on the Library Board for Silverchair and Silverchair actually built McGraw Hill’s AccessMedicine product. I want to thank those who reminded me of that.  It was never my intention to hide that information, I just was more focused on the actual product and the review and honestly forgot about Silverchair’s involvement.  So I guess with ties to iMedicalApps and AccessMedicine, you could say I am equally(?) conflicted?

Despite the various possible conflicts of interest, I really just tried to expand on the orginal review of the two platforms and correct an error. 

First, let me address the obvious error within the review.  The author of the review compared the search features of the Inkling platform and the AccessMedicine platform. 

“Both AM and Inkling have search capacities, but Inkling’s is far superior. First, Inkling confines its search only to Harrison’s and it retrieves every table, figure, and text finding. AM, on the other hand, has a website-wide search function that doesn’t just give Harrison’s results but also the results from other titles in the AM library.”

This is incorrect.  AccessMedicine’s Harrison’s can search only within the book.  The author of this review failed to notice the drop down arrow next to the search box that allows one to search only within Harrison’s.  See image below.


This a pretty obvious error.  Now I admit the default for the search box is AccessMedcine (as you can see) but just clicking the arrow you can easily limit your search to Harrison’s.  Perhaps AccessMedcine might want to consider making the default for the Search dependent on where the user is on the site.  If the user is within Harrison’s then the default is Harrison’s.  If the user is in Goodman and Gilman’s then the default is Goodman and Gilman’s.  If this is possible, this would help people out.

Second, I feel the reviewer needs to be a little clearer regarding the search results within Inkling and AccessMedicine.  The reviewer takes issue with the number of times the term heparin was found within AccessMedicine’s Harrison’s vs Inkling. 

“Moreover, the power of the Inkling search is greater than AM’s. I retrieved 50 matches when I searched Heparin on Inkling. In AM, I only retrieved 13 matches, most of which were tables, rather than mentions of heparin within text chapters. Harrison’s is such a mammoth text that a powerful search function is essential, which Inkling provides and AM does not.

This statement implies that the reviewer only looked at the search results screen from Harrison’s and counted on the number of retrieved results.  They are correct that most of the retrieved results were tables where heparin was mentioned, and only one result was where heparin was mentioned within the text of Harrison’s.  However, this is kind of misleading.  This implies that the term heparin was only mention once in the entire book of Harrison’s on AccessMedicine, which is not the case.  When you do a search for heparin in AccessMedicine’s Harrison’s, the top result (see image below) is a whole chapter on antiplatelets and anticoagulants (Chapter 118).  Yet in the reviewers own screen shots, a search on heparin in Inkling also lists mostly tables AND the most relevant information (the chapter that heparin is mentioned) is listed far down on the retrieved results.  I would have thought the chapter is more relevant than the tables (and given the tone of the review, so does the reviewer) but it would seem from the Inkling screen shots that it isn’t because listing for the chapter burried below the results for tables.


The whole chapter in AccessMedicine’s Harrison’s has over 100 mentions of the term heparin (as shown in bright red circle below)


So my question for the reviewer is whether Inkling retrieved more hits because it was counting the multiple times the term heparin was mentioned in the chapter on anticoagulants OR did it find more instances of the term heparin within OTHER chapters of Harrison’s.  This is kind of an important nuance when you are looking at search results.  Because if Inkling’s 50 hits were all within the same anticoagulant chapter then the search feature is similar to AccessMedicine’s and the results are just presented differently.  (Here is a whole chapter on heparin vs. here is where it is mentioned every single time in the chapter.)  But if Inking’s search found more instances of the term heparin within other chapters of the whole book then the search features on Inkling are picking up something that AccessMedicine isn’t.  Is this good or bad?  It really depends.  Is it picking up relevant results like the paragraph on heparin in Chapter 370 Cerebrovascular Diseases (ischemic stroke section) or is it just picking up the term where it is used briefly in a sentence and really has little relevance if you truly searching the subject heparin?  It is also important to remember that Inkling’s results for heparin were not as relevant because the chapter was listed the tables.

When looking at the strength of search engines more than a mere word count needs to be discussed if we are to really understand which platform has the best search features.  Relevancy is way more important than sheer number of results, look how much junk floats to the surface of some Google searches.  Unfortunately this was not discussed in detail enough for us to determine whether Inkling’s search engine is really better (retrieves more relevant results). 

The reviewer does correctly mention that AccessMedicine has the most updated information from Harrison’s.  Updates are made continuously online through AccessMedicine, therefore a reader doesn’t have to wait for a new printing of the book.  “It is uncertain whether Inkling will enable the same kind of updates.”  The reviewer surmises that Inkling will update their version when the next edition of Harrison’s is available (much like a print edition schedule).  However, the reviewer omitted to discuss the e-chapters within AccessMedicine’s Harrisons and whether they were available on Inkling. 

There are over 50 e-chapters that according to AccessMedicine are only available online (image below just captures the last chapters with the note about the e-chapter logo). 

 That is A LOT of addition e-content.  Some of those e-chapters are tutorials and videos but others are actual chapters not “ancillary content.”   

Some chapters that are e-content only:

  • Primary Care in Low and Middle Income Countries
  • Complementary, Alternative & Integrative Medicine
  • Ethical Issues in Clinical Medicine
  • Approach to the Patient with a Heart Murmur
  • Mitochondrial DNA and Heritable Traits and Diseases

It is imporant to know whether Inkling’s text has these same chapters as AccessMedicine or whether it is missing chapters.

Finally, the reviewer seems to have a slight bias toward student use.  The reviewer seems to dismiss the charts, tables, and PowerPoint lecture slides. 

“There is also some ancillary material that the AM version gives that Inkling does not. Nearly every chapter in AM’s Harrison’s has powerpoint lecture slides that have figures and tables from the book. This is not of great importance to most students I suspect, but instructors may care.”

Maybe some students may not care about slides, figures, and PowerPoint slides, but if you have to give a presentation you probably care a lot. As a librarian at a large research medical center I can tell you this type of “ancillary material” is asked for and used more than the reviewer would think.  For example I can’t tell you how many times I used to get asked about NEJM’s PowerPoint slides and how they could download them.  (I am not unique, other librarians have been asked this too.)  So I would say that Harrison’s slides, charts and tables are more than just mere ancillary material that only instructors may care about.  I think if you are doing any  research, publishing, and presenting you will be very happy to have another resource for your papers and presentations. 

 Now that I have pointed out the things I found to be lacking in the review, I do want to mention some of things that I feel the reviewer correctly hit on. 

Note taking within AccessMedicine’s Harrison’s is not helpful and all types of users, including students, take notes.  If you have created your own personal MyAccessMedcine account you can “Bookmark” chapters and items, but you really can’t take notes. 

The reviewer is also correct that if you want a version of Harrison’s that is not dependent on an Internet connection then Inkling is for you.  However, as hospital networks improve I see this locally loaded feature (of any product not just Inkling) to be less of an issue.  The cloud is the future for information storage and retrieval. But I do recognize this is a personal taste issue, some people just like having content loaded locally.

The way AccessMedicine limits readers to view only sections at a time is frustrating and a barrier.  As a result AccessMedicine’s Harrison’s Online is not an easy book to read online.  Inkling’s version appears to be very easy to read online based ont he review.  The reviewer correctly mentioned the reason for divvying up the book into sections was to prevent online piracy.  Unfortunatly, this does little to prevent piracy and more to inhibit real usage. (People are scanning entire books and making them available online. AccessMedicine does little to prevent guests from creating a MyAccessMedicine password at a subscribing institution and using it well after they are an authorized user.)  It appears from the review, Inkling’s book is much more user friendly to read in a sitting rather than the AccessMedicine version.  AccessMedicine’s presentation is limits its use.

Personally, I think the decision to use AccessMedicine’s Harrison’s vs Inkling breaks down into 2 parts.

1. If you want to stay current and have the most recent information then you need to use AccessMedicine’s version.  Inkling has not indicated their update schedule and AccessMedicine always updates Harrison’s.  The reviewer did not mention if e-chapters are in Inkling’s version, if they aren’t then you are missing chapters.

2. If you are not as concerned about the timeliness of the information (or the possiblity of missing e-chapters) and you want an easy to read experience with the ability to take notes and read offline then Inkling’s version is what you want.