Back in the olden days a library bought a subscription to a journal and they paid the institutional price which was often listed on the inside cover of the printed issue. It was always more expensive than the personal subscription, but there wasn’t tiered pricing, FTE pricing, or pricing based on inpatient admissions and number of specialists. For the most part the price you saw on the inside cover was the price you paid.
Then came the electronic journal. At first journals weren’t quite sure how they were going to have their articles online. Some gave it away free, others were free with a print subscription, some charged a nominal upcharge, while some charged a specific online journal price. Ejournals grew in usage and with tightening budgets librarians began dumping the duplicate print. During that time institutional prices evolved to a Ladon of possibilities.
Additionally, the concept of eresources has moved beyond journals. It extends to books, databases, integrated EMR and patient education products, image databases, etc. As librarians we demand to know our usage statistics for our eresources. We need to know what our patrons are using so we can get the most bang for our buck. However, we aren’t the only ones who see our usage statistics. The vendors that sell us our products run the reports and it isn’t in their best interest for us to get the biggest bang out of our buck. I am not trying to imply that all of the vendors are nefarious. I am just saying that if they see that your cost per use stats are so phenomenal that they may be looking how to get more money from you. For example you are paying $50,000 for a product that you use so often that you have $.05 per use but the average library in your tier pays about $.10 per use, the vendors think you are getting their product for a $50,000 discount compared to others in your tier.
Prior to eresources, vendors knew very little about the usage of their product in the institution. The usage of printed journals and books were often only known by the librarian through shelving studies or circulation statistics. I remember when we had CD Plus and had to load the MEDLINE CDs on a CD tower for people to search. Despite not having the type of usage data we have to today, librarians still looked at how their databases were used (Volkers AC. Bull Med Libr Assoc. 1995 Oct’ 83(4):436-9.) and even tried to determine journal needs through the database (Dunn, K. Medinfo. 1995;8 Pt 2: 1428-32.) The usage stats were all in house. So while you might have known what your cost per use was for a journal, book, or database there was no way that a vendor knew, unless you published it in a journal article that they read.
It seems that with wide scale use of eresources, usage stats have become a double edge sword. Not only do we still need to know what is being used but vendors now also know what we are using. They can use this information to their advantage as well. While neither party wants to have a resource that is a dud, I’ve got to wonder if we are now also victims of our own success. Many of us have already cut the chaff from the wheat years ago. All of our eresources are high performers. Yet because they are high performers are they costing us more than if they were less utilized? If so isn’t that the exact opposite of what a librarian needs to be thinking about?
Betsy Kelly, Claire Hamasu, and Barbara Jones wrote an interesting article, “Applying Return on Investment (ROI) Libraries. (Journal of Library Administration. 2012;52(8):656-71.) Determining the ROI is necessary to measure the value of the library resources to the institution. Many medical librarians use the NN/LM MCR ROI Calculator to determine the replacement value of services provide by the library. In addition to quantifying the number of classes, room use, photocopies, and ILL’s the calculator can also factor in the cost of ejournals, databases, ebooks and their usage. So in order to get a good ROI we want high usage for these electronic resources.
ROI is what hospital administrators are looking at when it comes to everything. Hospital administrators are focused on controlling costs and demanding the biggest savings possible. According to an article from the Daily Beast about the Cleveland Clinic , CEO Dr. Cosgrove is described as something of a “fanatic” regarding controlling costs.
“Our physicians are so engaged in our supply chain that they help negotiate the price down for the things we use,” Cosgrove told me (Daily Beast), and reeled off a list of examples:
- When I was the head of surgery, we needed a new heart-lung machine, and we decided there were three models that could work, so we did a reverse auction to get the lowest price.
- We put price tags on things in the operating room: before you open that $250 set of new sutures, make sure you actually need it.
- We found out that there’s a lot of redundant tests that are done, or tests that won’t be vital to the patient’s care. We know that there are some things that don’t change. For example, the reticulocyte count can’t change but week to week. So if someone’s ordered a reticulocyte count, you can’t ordered another for a week.”
I might be going out on a limb here, but I have to think that all administrators are pretty fanatical about costs and keeping them low. So how does the idea of keeping costs low factor in with eresources? Are we at a point with some resources that good usage is actually hurting us, costing us more come negotiation time (if we can even negotiate)? In the spirit of the $250 suture kit, do we start adding a price tag to our eresources before users click on them? That would be kind of absurd and certainly would drive down our usage stats which in turn would drive up our cost per use.
In this day and age where we use our usage statistics to drop resources and vendors use them to determine pricing, how are we to come to a even playing field when our budget is shrinking and our administrator wants to see increase cost savings? We struggle to show our ROI on a smaller and smaller budget as our resources increase in price. We explain to administration that if they didn’t have us to do what we do it would actually end up costing them a lot more in time and money to provide the same resources and services. But as Kelly et al mention, the “problem with ROI calculations based on cost avoidance is the underlying assumption that users will look elsewhere to purchase the same services and resources they receive from the library. It is not realistic to assume that users could afford or would make the effort to personally pay for all of the services they receive.” Hospital administrators are essentially already doing this. By cutting the library’s budgets to the bone they are forcing librarians to not pay for all of the same services and resources. When a hospital library closes, the budget for those electronic journals, books, and databases (as well as everything else) is gone. Almost none of the resources are kept by the institution. When administration closes a hospital library, they are not replacing the same services and resources.
Usage statistics help librarians determine ROI to hospital administration, but what are we to do when administration wants to see usage and ROI go up but vendors increase the price (thus decreasing our ROI) as a result of our usage stats? It seems as if librarians are between a rock and hard place. Do we need to look at another method of valuing our services and resources? If so, what?