Ebooks at Barwon Health Library: a case study

Abstract

This study measures the usage of print books and ebooks at the Barwon Health Library, Geelong, Victoria, from 2012 to 2014 as a means of predicting future use. A literature review was conducted to identify studies of ebook usage and factors affecting the balance between print and ebook usage in hospital and health libraries around the world. In 2014, the authors collated data about the Library's print and ebook collections: collection size, expenditure on print books and ebooks, and usage statistics. The literature review showed that in health/hospital libraries, the use of ebooks was increasing, with static or declining use of print collections. Factors affecting use included availability, accessibility (to content and technical mechanisms) and discoverability, with some flexibility around format preference. Cost and other limitations were ongoing challenges for health libraries. Data collected for this case study indicated a reversal in the balance between usage of print and ebooks, with about 30% print versus 70% electronic being the proportion reached in 2014. On average, the cost per download of an ebook was almost double the cost of a print book loan. Trends and factors affecting use as identified in the literature review were reinforced in this case study. A number of changes in the local context have affected the ability of the Library's clients to use the collections. Although it is not possible to say how these will affect collection use in the next few years, it is likely that with an increasing client base, coupled with improved availability and accessibility of ebooks, overall ebook usage will increase, accompanied by a drop in average cost per download.

Keywords::

• health libraries
• ebooks
• usage studies
• cost analysis
• collection development

Implications for best practice

• Use of ebook collections in health libraries can be increased by promotion and training clients more effectively.

• Use of ebook collections in health libraries can be increased by engaging with clients to create new ways of integrating ebooks into their clinical, study, teaching and research workflows.

• Barriers to ebook use in health libraries can be reduced by providing better discovery, access and usability mechanisms.

• Health librarians can reduce costs by careful selection of ebook titles in accordance with client needs and standard recommended lists, and by negotiating more favourable terms and purchasing models with vendors.

Introduction

The ebook phenomenon is a growing area of interest for all stakeholders in the book industry, including libraries. Several authors have noted that we are in the early stages of a much larger phenomenon than is currently evident. An essay in The Economist on the future of the book, ‘From papyrus to pixels’ is subtitled ‘The Digital transformation of the way books are written, published and sold has only just begun’ and concludes: ‘Books will evolve online and off, and the definition of what counts as one will expand; the sense of the book as a fundamental channel of culture, flowing from past to future, will endure’ (From Papyrus to Pixels, 2014, p. 26). This prediction of endurance bodes well for libraries, whose future appears to be inextricably linked with the future of the book. As well as questions of survival, however, all types of libraries (including health libraries) are vitally concerned with the ways in which books are evolving. Exactly how they endure, with all the variations in formats, cost structures and pricing models, distribution channels, availability and accessibility, affects the capacity of libraries to develop and manage their collections and serve their patrons.

eBooks have been described as a disruptive technology, alluding to the fact that we are not simply in a period of evolutionary change. Wilson (2014) stated that ‘the e-book has the potential to disrupt the processes for the production, distribution and use of authorial texts, and is already in the process of doing so’. He highlighted two areas of particular concern for libraries: ‘user demand is raising the problems of how to manage e-books within their collection development and management processes, as well as how to negotiate with publishers on price and other aspects.’ LaRue (2014) suggested that we are only in the second of three phases of disruption, and that a new paradigm of digital publishing and a new purchasing model has not yet reached maturity.

A study conducted in 2011 into Australian books in the digital era (Book Industry Strategy Group, 2011, p. 5) found that libraries were especially concerned about the impact of digitisation, the related costs of licencing materials and the impact on budgets and their ability to serve their communities, and the cost of preservation of cultural heritage material in accessible formats. Health librarians have expressed similar concerns, particularly with regard to costs and budgets, and the ability to maintain a valuable lending service for their clients. In an article highlighting some of the collecting dilemmas for Australian health librarians, Due stated that while their investment in ‘first class lending collections’ has been a good one, and that ‘book loans in hospital libraries have risen by fifty percent in the last ten years the arrival of the e-book is forcing health libraries to reassess the value of the printed book’ (2012, p. 27).

In addition to the questions related to costs, loans and value, health librarians are clearly interested in the topic of ebooks and the usability of the ebook format, as approximately a third of the respondents to ALIA's research into ebooks and interlibrary lending came from the health sector (Australian Library and Information Association [ALIA], 2014, p. 4).

Objective of the study

In November 2013, ALIA released a statement which predicted that ‘library print and ebook collections will establish a 50:50 equilibrium by 2020 and that this balance will be maintained for the foreseeable future’ (Australian Library and Information Association [ALIA], 2013). The following implications for libraries were proposed:

• Shelf space will be freed up, allowing for different uses of space and user-focused collection management and reader advisory services.

• Collection budgets will need to increase, to provide titles in both print and ebook formats.

• New skills will be required.

In order to explore the issue of the balance between print and electronic, the meaning of ‘equilibrium’ must be defined. Equilibrium could refer to the size of the collection (number of titles), the budget for print and electronic monographs, the usage of the collections (number of loans of print books and downloads of ebooks) or all of these criteria. For the purposes of this article, data on all three of the above criteria were collated for the past 2 years.

ALIA's 2013 prediction was revised in March 2015 (Australian Library and Information Association [ALIA] 2015) as the initial boom in ebook sales appeared to have settled. It was predicted that print books would remain the dominant format and the proportion would be closer to 80% print and 20% electronic. The purpose of this study, however, remained unchanged: that is, the primary objective was to measure the usage of print books and ebooks at the Barwon Health Library during the 2012 and 2014 period as a means of predicting future use of both formats, and the likelihood of reaching a 50:50 equilibrium by 2020.

Setting

The Barwon Health Library is located on the campus of the University Hospital Geelong, which is classified as a large regional teaching hospital and has a catchment area reaching from Geelong (Victoria) to the South Australian border. Barwon Health has over 6000 employees (fulltime equivalents); about 3000 of these are health professionals (clinicians), of whom 380 are junior doctors. In addition, there are around 160 medical students, and Barwon Health has agreements with 30 odd educational institutions to take students on clinical placement. The Library's primary responsibility is to support Barwon Health's mission ‘to provide accessible high quality healthcare services to our Barwon South Western region communities’. The Library has almost 2000 members who have access to all services and are eligible to borrow from the collections, and almost 600 members who have registered for online access to additional ebook titles. Most of the Library's members use the services, collections and facilities to support their clinical (patient care) information needs, study and teaching activities, research, and continuing professional development.

The Library's Collection Development Policy (Barwon Health, 2014a) states that the three essential functions of the Library's collections are to:

• fulfil Barwon Health's governance responsibilities by ensuring that evidence-based information resources are available to inform clinical decision-making and policy development;

• satisfy clients’ needs for information for the purposes of clinical decision-making; education, training and professional development; research and service innovation; policy and planning; health technology assessment; and management and administration;

• fulfil the requirements for teaching hospitals to meet the national standards of specialist professional colleges and other accrediting bodies.

The policy states that where there is an equivalent publication, the electronic publication will be preferred over a print publication for four reasons:

• equity of access facilitated by simultaneous and multiple online access points;

• emergence of new hybrid products, for example, point-of-care reference tools;

• safe preservation and storage conditions;

• costs of managing physical collections, including space.

The policy also states that ‘The Library aims to hold the most recent editions of all types of materials in the print and electronic collections.’ As reference books are continuously being updated, maintaining currency by subscribing to (or purchasing, depending on the model adopted) the latest edition of prescribed texts is clearly facilitated by the electronic format. In the health care context, where access to the latest evidence-based information resources is critical to decision-making in patient care, electronic resources have clear benefits when compared to the restrictions of place and currency of the physical format. Thus, the preference for electronic reference texts has been stated at a policy level. In practice, this has meant that the budget for print monographs has been reduced while the budget for ebooks has increased (in fact expenditure on ebooks has already exceeded expenditure on print books). It has also meant that the current edition is more likely to be an ebook, and this in turn will drive up the usage of ebooks.

There are a number of vendors in the health ebook market, offering a range of purchasing (i.e. ownership) and access (i.e. subscription or leasing) models. The Barwon Health Library has used a mixture of these, including purchasing single titles of reference texts, purchasing selected titles from publishers' packages, annual subscriptions to publishers' ebook packages, and annual subscriptions to publishers' packages which include materials in other formats. Almost all titles are offered without restrictions on numbers of users.

Method

The research was conducted in two stages: a literature review, and the collection and analysis of print and ebook data.

Literature review

The literature search was restricted to the topic of the use of ebooks in health and medical libraries where the primary client groups were health practitioners and clinicians. The search was conducted in August 2014, covering the years 2000–2014. Databases searched were: PubMed, EBSCOhost (MEDLINE, CINAHL, PsycINFO), ProQuest (LISA, ProQuest Science) and Embase. The search strategy was based on relevant Medical Subject Headings (MeSH) terms and text words:

(ebooks[All Fields] OR ‘electronic books’[All Fields] OR ‘online books’[All Fields] OR ‘e-books’[All Fields]) AND (‘medical libraries’[All Fields] OR ‘health libraries’[All Fields] OR ‘health sciences libraries’[All Fields] OR ‘hospital libraries’[All Fields]).

Individual journal titles searched were: Health Information and Libraries Journal, Journal of the Medical Libraries Association, EBLIP Journal, HLA News: National Bulletin of Health Libraries Australia and Health Inform. Grey literature reports, studies and additional open access articles were identified by searching professional association, government agency and other library information websites.

Articles included and excluded

Just over 60 peer-reviewed articles were found in academic journals. No further refinement of the search strategy was required as this number could be assessed to identify articles which focused specifically on usage of ebooks and/or comparisons of print and ebook usage. Abstracts and full-text articles were screened to identify English language studies of any sample size and design on the topic of usage of ebooks in health/medical libraries where the primary client groups were health practitioners and clinicians. Articles about health libraries which also served health academic staff, researchers and students were included in the literature review as long as health practitioners were identified as one of the main client groups.

Articles excluded from the literature review were: studies set in academic libraries where students were the main client group (and the library did not serve health practitioners even in a minor way); studies about online resources generally (but not specifically stating that ebooks were included); conference/workshop/meeting reports; critical appraisals of articles; descriptions of non-library ebook resources; studies focusing on website design, mobile devices, or CD book formats; reviews of ebook products or platforms; and non-English language articles. eBook product and platform reviews were analysed separately to inform the discussion of features, functionality and issues influencing ebook usage, but were not included in the literature review.

Usage studies: broad findings

Nineteen articles were eligible for inclusion in the literature review (see Appendix). The broad findings of the literature review suggested that print books were maintaining a fairly constant level of use, while at the same time usage of electronic materials was steadily increasing, and the need to maintain both formats was posing problems for collection managers. The main factors affecting usage of ebooks related to availability of equivalent texts, accessibility of content (discoverability) and usability of technology. Other factors included user format preference and purpose of the resource (each relating to user behaviour), and cost barriers. No studies analysed cost per-use-data as this current study has done, although some articles discussed the issues of limited budgets and rising costs of resources as barriers to purchasing ebooks.

Usage studies: balance between print and electronic

Morgan (2010) conducted a usage study in an academic medical library whose clients included interns and residents rotating in the hospitals, and part-time faculty who were also practitioners. The study examined circulation and vendor data and compared the use of print and electronic resources, reporting that in contrast to the level pattern of use of print books, ebooks were increasing steadily. The authors explored some of the factors affecting usage, which included selection of titles, accessibility within the different collections (for print titles) and different packages (for electronic titles), and promotion and inclusion in information literacy training. Their conclusion highlighted an important advantage of ebooks, which ‘can provide multiple user access to the most recent edition, which is generally updated on a regular basis. In contrast to printed volumes, users do not have to settle for an older edition because the current edition is signed out’. They concluded: ‘While the difference in counting can account for some differences in the numbers of e-book usage versus print book circulation, it cannot negate the static trend for print titles and the positive trend for electronic resources’ (p. 16).

Ugaz and Resnick (2008) analysed their library's medical reference core collection to compare use over a 14-month period of a matched set of 51 unique titles available in print and electronic formats (41 of which were in the Brandon/Hill list of core medical texts). The aim of the study was to assist in decision-making regarding collection development and retention of core reference texts. Usage of electronic texts was found to be far higher than usage of print texts, and it was decided that the electronic version would be designated the reference copy, with print copies being relegated to circulating collections. The authors noted that the electronic format is suited to use as a reference tool but there may be preferences for print for other purposes, and concluded that promotion and education of electronic resources was important.

Kananen, Ovaska, and Saarti (2006) had similar findings to Morgan with regard to the balance between print and electronic. The authors conducted two surveys (2004 and 2005) about the use of all types of library services and resources by all user groups of the Kuopio University and Kuopio University Hospital libraries in Finland. Analysis of the data from usage statistics and user surveys showed that ‘the library use is divided half-and-half between the traditional use of printed material and library premises and the modern use of digital materials via the Web’ (p. 183). Using a sub-set of the data, the authors quantified the increase in the use of electronic books in the hospital library (one of the sites included in the study), stating that ‘the use of traditional books has been maintained at the same time that the use of electronic books has increased by almost 30 per cent per year’ (p. 184).

Availability of ebooks and accessibility of content

No clear conclusion can be drawn from the literature about the availability of ebooks for use as medical reference texts to replace print equivalents. MacCall (2006) assessed the availability of electronic medical textbooks by checking publishers' lists against a standard (the Brandon/Hill list), noting that at that time almost 50% of titles were available, covering 71% of medical topics. He concluded: ‘the number and range of online medical books is reaching a point where collection-level consideration is warranted to facilitate efficient use and prevent the problem of split files’ (p. 80). To assess availability, and particularly the accessibility of content within book chapters, MacCall sampled US medical library websites. He highlighted the differences between the attention that was paid to improving accessibility to journals and their contents in the transition from print to electronic journals when compared with the transition to ebooks, where there was limited analytical access (‘bibliothecal arrangement’) at a granular level (chapters or sections). Also an issue of accessibility, the problem of ‘split files’ (defined as ‘dividing and separating [of] things that belong together’) was described:

If health sciences libraries rely only on the analytical search tools of the various online publishers, then users are not able to take advantage of the benefits of integrated digital library collections and are therefore subject to either incomplete information or additional labor to find and compare information held in the medical books of different online publishers.

Lorbeer and Mitchell (2008), speaking from their experiences in a US academic medical library, stated in their abstract that ‘while e-books are certainly a good investment, they definitely cannot yet be seen as equivalent alternatives to print books.’ Husted and Czechowski (2012) reported on a collection analysis which compared the availability of ebooks with the print reference collection and standard collection development lists as the benchmarks. They conducted their analysis with a view to provide access to an online reference collection to a widely dispersed user population. They concluded that low availability of electronic versions made the creation of an online reference collection impractical.

User studies and use of mobile devices to read ebooks

Two studies looked at health professionals' use of mobile devices for reading ebooks. Logan and Collins (2009) surveyed medical residents in a hospital library in Canada, and found that more than 90% of those surveyed used PDAs in their clinical practice, with 32% responding that they used PDAs for consulting a textbook (p. 4). Wu, Chatfield, Hughes, Kysh, and Rosenbloom (2014, p. 127) conducted a survey implemented at seven health sciences libraries to find out about ownership of technological devices, awareness of new technologies, and interest in using devices and technologies to interact with the library. Although students were the main focus of the survey, there were some institutions where health professionals were included. Results indicated that 25% of respondents were ‘likely’ and 28% ‘extremely likely’ to use their smartphones or tablets to read e-books. Thus, it seems likely that in a health care setting, somewhere between 30% and 50% of library clients are likely to read ebooks on mobile devices.

Factors affecting ebook usage

A number of studies explored factors affecting the use of ebooks. Bell, Glover, Brodie, Roberts, and Cleghorn (2009) found that the type of library service and employment of an outreach librarian had an effect on usage of electronic resources, including ebooks. They conducted a large-scale retrospective quantitative study of staff in the National Health Service, North West England in 2007. Athens sessions log data of 8273 staff of Primary Care Trusts (PCTs) and 100,599 sessions were studied. They concluded:

This study presents strong evidence to suggest that PCTs with their own library service or a dedicated outreach librarian have the greatest impact on electronic resource usage, compared with those with no library service or an SLA with an acute trust. (p. 140)

Folb, Wessel, and Czechowski (2011) conducted a web-based survey distributed to a random sample (n = 5292) of holders of library remote access passwords, in which, including partially answered questionnaires, they achieved a response rate of 18.5%. They found that the users' role at their primary institution, job category and purpose affected the use of ebooks and format preference. In general, results showed that just over half of the respondents had used ebooks. More than 70% of physicians, interns, residents or fellows had used ebooks for clinical care, and there was a preference shown for print for textbooks and handbooks, and electronic format for pharmaceutical and reference books (p. 224). Respondents also indicated high flexibility about format choice.

Hartel and Cheek (2011) conducted an exploratory study in an academic health sciences centre, looking at issues of accessibility and preferred formats for different purposes (education, research and patient care). The study was limited by a small number of participants (convenience sample of 16). They noted that ebook usage had increased every year, and this was related to a promotions tool developed at the library, linking ebooks to the online course management system, and distribution of mobile devices to users. Overall, the print format was rated the most intuitive and easy to navigate as well as the most satisfying (p. 314). The authors identified access and promotion as being critical to the uptake of ebooks. Similarly, Flake (2010) in a case study based in a US hospital found that integrating the library's electronic resources (including ebooks) into the electronic medical record facilitated access (no passwords were required), and active promotion increased usage.

Foust, Bergen, Maxeiner, and Pawlowski (2007) reviewed the results of a usage study of their university libraries’ medical/health ebook collections, facilitated by the libraries’ federated search tool, demonstrating that discoverability affects usage. They concluded that this search tool was effective as a way of searching across large collections. Czechowski and Tannery (2011) also reported the results of their 5-year reflections on the use of this tool which provided access to the collection of 2500 ebooks. Samsundar (2007) reported on the experiences of hospital librarians in their implementation of an online catalogue which improved the discoverability of ebooks.

Challenges discussed in descriptive studies

Four descriptive studies identified additional challenges to those described in this literature review. They expanded on the issues associated with having limited resources, budgets and staffing skills; availability, accessibility, equity and differences between types of libraries and large and small libraries in the health and academic sectors; and costs and purchasing models. Most contended that while ebooks were useful resources and demand was increasing, their uptake, at least in the early 2000s, had been slow.

Due (2012, p. 27) highlighted the similarities between the introduction of electronic journals, where print subscriptions had been replaced by an online access (rental) model, in which usage and collection evaluation data moved from local loans records to vendor system-generated statistics. In comparison, he noted the retarded rate of ebooks' replacement of print books. Due summarised the main challenges for small hospital libraries with limited staff time and budgets when seeking to maintain print at the same time as developing ebook collections: how best to acquire, organise, promote and make these resources accessible. With regard to acquisitions, he stated:

Libraries must acquire e-books in large bundles. It is simply not practicable to be purchasing single titles as we do with printed books. Moreover, experience shows that e-book collections need to reach a critical mass before they are really useful – thousands are needed rather than tens or even hundreds.

Caldwell (2005) reviewed the experiences of UK academic and healthcare libraries with regard to medical ebooks, noting a relatively slow uptake in the National Health Service, and problems associated with sales models and suppliers.

Ketterman, Hoover, and Cable (2012) described a collection development policy for a shared neuroscience ebook collection which was implemented primarily as a cost saving measure amongst a group of academic health sciences libraries. Schott (2010), in a descriptive study of a hospital library, highlighted the issue of equity, observing that a digital divide precipitated by the rising costs of digital resources was revealed when medical students rotated between larger and smaller hospitals.

Collection and analysis of print and ebook data

In this case study of the Barwon Health Library, data were collated to cover the years 2012–2014 on the three indicators of interest: collection size (measured by number of items in the collection), budget (measured by expenditure on monographs – print and electronic – for the financial years 2012–2013 and 2014–2015) and usage (for print, this was measured by loans system transactions, and for electronic, by downloads data from system vendors). In addition, average costs per use for print and electronic items were calculated by dividing the expenditure by the number of loans and downloads.

Results and analysis

As shown in Table 1, data collected on each of the criteria indicated a reversal in the balance between print and ebooks.

• Collection size: in 2012, 58% of books were in print and 42% were ebooks; in 2014, 44% of books were in print and 56% were ebooks.

  Table 1 Print and ebook collection size, budget, usage and cost per occasion of use, 2012–2014.

  	Print	eBooks
  Collection size
  2012: Items in the collection	58%	42%
  2014: Items in the collection	44%	56%
  Budget
  2012/2013: Expenditure ($)	38%	62%
  2014/2015: Projected expenditure ($)	18%	82%
  Usage statistics
  1 August–31 October 2012: (loans/downloads)	70%	30%
  1 August–31 October 2014: (loans/downloads)	30%	70%
  Cost per occasion of use
  2012: Average cost per loan/download = 3.7 times as much for ebook per use as print book per use	$1.84 per loan	$6.72 per download
  2014: Average cost per loan/download =  almost double the cost ebook per use as print book per use	$3.18 per loan	$6.16 per download

• Budget: in the 2012–2013 financial year, 38% of the monograph expenditure was on print books and 62% was on ebooks; in 2014–2015 the budgeted expenditure was 18% for print and 82% for ebooks.

• Usage statistics: for the period 1 August to 31 October 2012, 70% were print books (loans) and 30% were ebooks (downloads); for the same 3-month period in 2014, these percentages were reversed.

Cost analysis showed that in the 2012–2013 financial year, the average cost per loan was $1.84 for print titles, and the average cost per download was $6.72 for electronic titles. The equivalent data for 2014–2015 revealed that cost per print book loan averaged $3.18 and cost per ebook download averaged $6.16.

The results clearly demonstrate that for the Barwon Health Library, the balance in terms of number of items in the collection and usage has shifted from print to electronic, while expenditure indicates a strengthening of the existing practice. When comparing average costs per loan or download, the print format continued to be better value for money spent, with ebooks still costing almost double the cost of print loans (a decrease since 2012 when ebooks cost 3.7 times as much per occasion of use). This was despite the fact that ebook usage had actually increased, while print loans had fallen. This suggests that ebooks were costing too much and had not yet proven that they were value for money. Factors affecting usage are explored in the Discussion section.

Discussion

Although the raw data on actual levels of use have not been examined in this article, this case study has reinforced the findings of the literature review as outlined in the section on broad findings, suggesting that print books were maintaining a fairly constant level of use, while at the same time usage of electronic materials was steadily increasing. What has changed is that the proportion of usage of electronic has increased, indicating that ebooks are in fact growing in popularity with users.

This case study also demonstrated ongoing demand for both formats, which has posed problems for collection management and budgets. While the collection development policy has dictated that electronic is the preferred format, the need to maintain print for particular purposes (for example, for in-depth study, or as a ward/department-based reference, or where there is no electronic equivalent) has meant that the print book budget has not been reduced to the extent expected if ebooks had been a complete substitute for print. In addition, the need to reach a large enough ‘critical mass’ of ebooks to be a ‘useful’ collection (as noted by Due, 2012, p. 27) has meant that a disproportionately large budget for ebooks was required, at least in the early stages of creating and developing an electronic collection. Again, the raw data on actual budget amounts have not been written about in this article, as the main purpose was to examine the shifting balance within the monograph collection per se. Over time, it is expected that the budget for monographs (whether print or electronic) will stabilise.

Most of the studies identified in the literature review focused on the shifting balance between print and electronic formats, and this was measured quantitatively and qualitatively by various methods including system data, collection analysis, client survey reports and predictions of client behaviour. Challenges, including costs and purchasing/supply models, were described in a number of observational studies, but apart from citing budget limitations as a barrier to purchasing ebooks, costs were not quantified. A number of articles explored issues of availability (ebook equivalence) and accessibility, both in terms of discoverability of the content and implementing facilitating technological tools, while some mentioned factors affecting use such as preferred format and relationship to the users' purpose, and type of library service offered.

Data gathered in this case study clearly demonstrated that for the Barwon Health Library, the balance was in favour of the electronic format, with the proportions on all measures being approximately 30:70 (possibly reaching 20:80 when projected expenditure for the current financial year for the two formats was examined), rather than the predicted equilibrium of 50:50.

The concern of rising costs of monographs for libraries as they struggle to accommodate steadily increasing demand for ebooks, without completely replacing the print equivalents, is a valid one. This study has indicated that ebooks are still costing more than double the cost of print books per occasion of use, suggesting that ebooks are costing too much and have not yet proven that they are value for money.

The local context

A number of local factors should be noted when examining the trends identified in the literature review and in analysing the results of this case study. The objective of this 2-year study was to explore the balance between print and ebook collections, and the three main indicators of this balance. The raw data have not been displayed in this article, and percentages have been calculated as comparative measures and indicators of possible trends. The time period is too short to identify any real trends, which will emerge over subsequent years as longer-term data are available.

Cost analysis was not the primary purpose of this usage study; rather it emerged as a variable of interest. Other factors would need to be taken into account for a valid cost analysis to be performed (for example, costs of processing, maintaining, storing, both onsite and offsite, and preservation of print books; for ebooks, there are costs associated with establishing and maintaining links, managing licences and access provisions, and electronic storage).

In this case study, the budget for monographs (both formats) has increased slightly for the period under study, and the proportion spent on ebooks compared with print books has increased. It would be expected that as the electronic collection grows in size, and the titles offered are refined to align more closely with clients' needs and the collection policy preference for selecting electronic resources, then if the initial investment remains the same, the cost per use would decline. This is, however, dependent on the Library's ability to make selection decisions and negotiate favourable purchasing, licencing and access models with vendors.

A number of additional factors affected the use of both print and ebooks in the local context. It is likely that these factors have had more of a negative effect on usage of print formats and a positive effect on usage of ebooks, but no attempt has been made to quantify them.

Prior to 2014, access to all collections was via the intranet-only catalogue, and in 2014 an Internet-based A–Z index was introduced, improving access to the Library's ebooks. In 2013–2014, the Library was temporarily relocated due to hospital building projects and physical access was retarded, with 5000 items in the current collection and double that in the offsite collection (these were still accessible on request).

In 2014, the collection development policy decision was made not to buy multiple copies of textbooks, so medical students were compelled to use electronic if they wanted a copy (if there was an electronic equivalent). Also in 2014, the Library's membership base increased with the introduction of a new Regional Members category (Barwon Health, 2014b), and rights to access a subset of the ebook reference collection were purchased to cover the regional members.

Conclusion

The start of this article suggested that the ebook phenomenon is part of a larger digital publishing environment. As a disruptive technology, ebooks appear to be only in the early stages of development. The issues for libraries relate to how ebooks are managed and incorporated into library collections, from both policy and practical perspectives, as well as in economic terms of budgets and pricing models. With regard to digital publishing and purchasing models, LaRue (2014) has suggested that libraries need to work with vendors who are more ‘nimble’ – a ‘new, hungrier, more engaged, more collaborative group of entrepreneurs [which] has just discovered the library market’. This case study has shown an imbalance in the print versus ebook cost-per-use data, suggesting that there are good economic reasons to be looking for new and more flexible purchasing and access models. The aim would be to explore less restrictive approaches in order to maximise use and deliver better value for money invested in ebooks.

In relation to the ALIA prediction that ‘library print and ebook collections will establish a 50:50 equilibrium by 2020’, this case study has demonstrated that this has underestimated the speed and size of the shift in this library, and the balance is moving far more rapidly towards a 30:70 split in terms of collection size and usage, while expenditure has already exceeded this ratio. It has not been possible in the current study to collect and analyse data retrospectively. The current study provides a baseline, and in the future, when a longer-term data-set has been collected, it may be possible to identify trends and predict usage patterns for this library.

While this study has provided a useful methodology for examining the balance between print and electronic book collections, the research design does not allow the results to be generalised to other health libraries or other sectors, as this would require a larger, multi-site study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Ann Ritchie

Ann Ritchie is the Director of Knowledge and Health Literacy at Barwon Health and is based at the University Hospital Geelong. She is the Convenor of Health Libraries Australia, and is a member of the Libraries Australia Advisory Committee, the Palliative Care Knowledge Network Management Committee, and the Editorial Advisory Board of the Health Information and Libraries Journal. In addition to health librarianship, her main professional and research interests are marketing, continuing professional development, mentoring and health literacy.

Helen Skoglund

Helen Skoglund is the Resources Librarian at Barwon Health, a role she has moved into and developed in the last 18 months after working for the last 15 years as a reference librarian. Her main responsibilities are managing the electronic and print collections, acquisitions, cataloguing and managing the library management system. She also has responsibility for client reference and collection development at Barwon Health's McKellar Centre Library, which caters for rehabilitation, aged care and palliative care.

Notes

^1. This paper has been double-blind peer reviewed to meet the Department of Education's Higher Education Research Data Collection (HERDC) requirements.

Appendix. Articles included in the literature review: usage of ebooks compared with print

Table

Study	Research question	Type of study	Measured by	Setting
Morgan (2010)	Use of print vs ebooks	Four usage studies	Circulation and vendor system data	Academic medical library, Canada
Kananen, Ovaska, and Saarti (2006)	Use of library resources and services, including ebooks	Usage study, two surveys	System data analysis	University health and hospital libraries, Finland
Ugaz and Resnick (2008)	Usage of print vs ebooks	Usage study	Usage data (vendor system and reshelving)	Medical sciences library, USA
MacCall (2006)	Availability of print vs ebooks and accessibility of content	Collection evaluation and website analysis	Benchmarking against a standard; content accessibility within chapters	Medical libraries, USA
Lorbeer and Mitchell (2008)	Equivalence of ebooks	Descriptive	Observations	Academic medical library, USA
Husted and Czechowski (2012)	Availability of print vs ebooks	Collection evaluation	Benchmarking against a standard	Health sciences library, USA
Logan and Collins (2009)	Use of ebooks on mobile devices	User study, online survey	Client (self) reports	Hospital library, Canada
Wu et al. (2014)	Use of ebooks on mobile devices	User study, online survey	Client (self) reports, future behaviour predicted	Health sciences libraries, USA
Bell et al. (2009)	Factors affecting use of ebooks: impact of type of library service	Usage study (large scale)	System data analysis	National Health Service, England
Folb et al. (2011)	Factors affecting use of ebooks, including role and purpose	User study, online survey, random sample	Client (self) reports	Health sciences library, USA
Hartel and Cheek (2011)	Factors affecting use of ebooks, including format preference	Exploratory, small scale, convenience sample	Client (self) reports	Health sciences library, USA
Flake (2010)	Factors affecting use of ebooks: access via the electronic medical record	Case study	Observations	Hospital library, USA
Foust et al. (2007)	Factors affecting use of ebooks: accessibility via a federated search tool	Usage study	Heuristic evaluation and web-server log analysis	Health sciences library, USA
Czechowski and Tannery (2011)	Factors affecting use of ebooks: accessibility via a federated search tool	Five-year reflection	Observations	Health sciences library, USA
Samsundar (2007)	Factors affecting use of ebooks: accessibility via an online catalogue	Case study	Observations	Hospital library, USA
Due (2012)	Balance of print and electronic – challenges	Descriptive	Observations	Hospital libraries, Australia
Caldwell (2005)	Use of ebooks and challenges, including costs	Descriptive	Observation	National Health Service, UK
Ketterman, Hoover, and Cable (2012)	Ebooks costs and shared collections	Collection analysis	Cost savings	Health sciences libraries, USA
Schott (2010)	Cost minimisation strategies using eresources	Case study	Observations	Small hospital library, USA