Hello MEDLIBers,

When I asked a couple of weeks ago about which department pays for UpToDate I got a lot of great responses (summary of replies below). Then I was asked to look into institutions similar to my own, a 500-bed community hospital, now I have been asked to expand to everywhere. So if you didn't reply before but are able to share who pays for UpToDate I would appreciate it. I think my boss would like examples of the medical staff or the main administration paying for it. Also if anyone has found a way to slow the pace of price increases, please, please, please let me know.

Thank you,

Karen Bontekoe
Medical Librarian

Summary of responses.

right now it is IT. Specifically the Epic (EHR) IT department. However, there is conversation that the library/e-resources may take over managing the contract.

We are a health care system (5 states), with 34 hospitals, and we have a system-wide contract

Heather J Martin
Director of Regional Library Services
Providence Health & Services
Portland, OR

Up-to-Date is paid for by the Medical Affairs Dept. here at CRMC.

Robyn Aguiar, MLS, Librarian
Community Regional Medical Center Fresno Medical Library 5th floor Annex M-F 8:30-5:00
ph: 559-459-3968 fax: 559-459-6243
[log in to unmask]

Don't know if you consider us an institution like yours (312 beds, teaching hospital).  We (the Library) pays for UTD.

Susan Klawansky
Seattle Children's
[log in to unmask]

For us it was the medical library budget  - we canceled because of growing sticker shock ;)

Kristina Flathers
Medical librarian
Nemours/ Alfred I duPont Hospital for Children

We are a 201 hospital. We provide the medical center and the family medicine center only with upd. We block all our other clinics and the college of nursing. We don't offer remote access.

Most of the cost is from my budget though I do get a yearly donation from the medical staff. It's the same amount each year even though the price goes up!!!
Halyna Liszczynskyj, MLS
Director of Library Services
St. Elizabeth Medical Center
2209 Genesee St.
Utica, NY. 13501
[log in to unmask]

The hospital and medical staff split the cost for uptodate and all other high costs, ie., medical staff journals and or other databases.

Evelyn L. Walker, BA, MS.
Health Science Librarian/CME Coordinator St. Vincent Medical Center
2131 W 3rd St
Los Angeles, CA.
213 484-5530
213 484-7092 (F)

When our partner hospital had UTD (in-hospital only), the medical staff office paid for it.  When we merged, the "sticker shock," as you so aptly put it, was sufficient that our senior execs told UTD to take a hike and we got Dynamed instead for one fifth the price.  The library got the money to pay for it.  Good luck!  Maybe now's your chance to get rid of it!  ;-)

Medical Library pays it here, and also did so at my previous hospital.
Ardis Weiss, MLS, BA
Medical Librarian
My job is to provide the information that you need to excel at your job. 
1798 N. Garey Ave., Pomona, CA 91767
[log in to unmask]

This sounds to me like a "made-to-order" donor opportunity, assuming that you're on site and deal with medical staff. 
Some MD groups, in particular, might be very interested for various reasons: subscription titles, public relations, potential tool for their accountants, relationship with the medical library ...  
It sounds to me as if you have some excellent ingredients for a wonderful menu !
A chat over a quick lunch in your cafeteria might benefit all parties. 
I speak from personal experience.

Adam G N Moore MD
Exeter, New Hampshire

IT pays. They purchased Provation as the thesaurus for the EMR. Provation is powered by UTD so they had to purchase 20 UTD seats. Oh, and staff on campus can google UTD and get in as pretty as they please. Slick. Very slick. Wait till the bill arrives after year one. 

Regards, Louise

In my two most recent hospital library jobs, one I still have and the other where I was laid off in 2013, the library paid for UTD at one and the medical staff paid for UTD at the other hospital. 

Keith Gleason
Medical Librarian
Alameda Hospital/Alameda Health System
2070 Clinton Ave.
Alameda, CA  94501
510-522-3700 x3331
[log in to unmask]

We are a 225 community hospital; the UpToDate annual cost is charged to the Library budget; the Library budget is under the Medical Staff Service umbrella, but the Library has to "own" the cost (meaning we have cut almost everything else in order to keep UTD).   :-( 

Columbus Regional Hospital (Indiana)

The Medical Library pays for UTD.

it is in our library, for now

Julia Stuart, Director
Health Education Library
New York Hospital Queens
56-45 Main St.
Flushing, NY 11355
ph: 718-670-1600
fax: 718-886-4503

Here at my hospital, it was IT for a number of years. Then it was put into the  library budget where it remains!  
Mary Loftis
Metro Health Hospital
Skytron Health Library
5900 Byron Center SW
Wyoming, MI  49519
fax: 616-252-0025
[log in to unmask]

The UpToDate invoice is split between the medical library and medical staff funds.

Sharon Henrich
Medical Library
Florida Hospital, Tampa
3100 E. Fletcher Ave.
Tampa, FL 33613

The library reports to IT and UpToDate is paid for out of one of their funds.

Alison Clapp, MLIS
Boston Children's Hospital
300 Longwood Ave.
Boston, MA 02115
[log in to unmask]

We are approx. the same size of community hospital with additional smaller hospitals in our system. UTD is paid for by: IT, Medical Staff (hospital and ambulatory), and library..... split 3 ways.

UpToDate for us is contracted through University of Pittsburgh and the cost for UPMC Hamot comes out of the Library Budget.

Linda L. Jeffery
Hospital Library Manager
UPMC Hamot Library Services
201 State Street
Erie, PA  16550-0001
Phone:  +1 (814)877-3628
Fax:  +1 (814)877-6188
e-mail:  [log in to unmask]

We have multiple hospitals so the library at the main campus foots the bill for uptodate. We have a medical student and multiple residency programs so I know the library is primarily funded by those groups. In a round about way med-ed pays for it. :-)

Kristina M Crofut, MLIS
Henry Ford Wyandotte Hospital
Medical Library
[log in to unmask]

I'm in a small (92 bed) community hospital and the library pays for UpToDate. I have had to go to the medical staff in the past, though, to ask them to help find money when we've had price increases. Would you mind summarizing?

Christina Stuntz, MLIS
Health Sciences Librarian
Mid Coast Hospital
123 Medical Center Drive
Brunswick, ME 04011
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Hi.  I'm at a 150-200 bed hospital (we merged with another hospital) and I, the Health Sciences Library, eat the bill for UTD.  It is enormous and I have stated emphatically that it is eating my budget up; all other disciplines' journals and databases are suffering because my budget is not increasing.  Beware the monster.

Susan B
Southern Maine Health Care

FYI. You will probably get different answers. In many hospitals libraries dropped UTD and switched to Dynamed because is cheaper and libraries have limited budget that doesn’t grow with the speed of UTD prices. Some have combinations as you had. We paid as a library, but prices went up again and our institution paid from their budget for all libraries.

Our hospital pays for this subscription since it was the doctors who petitioned for the resource. 

Rose Marie Lonergan
Medical Librarian
2815 S. Seacrest Blvd.
Boynton Beach, FL 33435
561-737-7733 ext. 84439
561-735-7080 Fax

Hi - funny you should ask. We are a similar sized teaching hospital. The library has paid for it on behalf of the whole health system, and then been reimbursed. However, I am considering handing it off to IS because they are a system-wide department (we currently are not), the product is integrated into the EMR - which they pay for,  and their budget is a lot bigger than ours, so when they take a hit - it hurts less.

Dina McKelvy, MLS, AHIP
Library Manager for Automation and Planning / Maine Medical Center Library
22 Bramhall Street / Portland, Maine 04102-3175
(207) 662-4080 ph / (207) 761-3027 fax
[log in to unmask]

The library pays for it here.

Angela Spencer, MLS
Manager of the Medical Library
St. Luke's Hospital, 232 S Woods Mill Rd., Chesterfield MO 63017

We are a Louisville system of 5 hospitals and the IS dept pays for UpToDate for all the hospitals in the system.   2 of our hospitals are teaching hospitals and the other 3 are community hospitals.

Ann L. Schaap, System Medical Librarian
Norton Healthcare Medical Library
P.O. Box 35070, Louisville, KY  40232
[log in to unmask]
(502 629-8127

IT pays for it at our institution. 

Mira E. Greene, MLS
Head of Technical Services
Moody Medical Library/Academic Resources
University of Texas Medical Branch
301 University Blvd., Galveston, TX 77555-1035 P 409.772.2393 M 281.685.0023 F 409.762.9782 E [log in to unmask]

So far we haven't been able to afford the UptoDate price tag.  I'd be interested to hear what responses you get, so please summarize.  Some of our other subscriptions are rapidly increasing in price, and I am also interested in what models are out there for sharing the cost with other departments like IT, for instance.

Here, if people want UptoDate, they buy their own individual subscriptions with the option to use their CME money to purchase.  Last summer, the medical staff looked at an option to pool ALL their CME Money to purchase an institutional subscription to UptoDate, but the proposal didn't get enough votes to fly.  People wanted to keep the flexibility of using their CME money as they wanted, individually.  Despite the many vocal fans UptoDate has, the content wasn't a good fit for everyone who could vote for the proposal.


Our IS/Medical informatics department pays. Too rich for our blood in the library.

Stephanie Harris, MLS
Reference Librarian
Library Services

Orlando Health
1414 Kuhl Avenue, MP 28
Orlando, FL 32806
tel: 321.841.5878
main library tel: 321.841.5454
fax: 321.843.6825

Our Uptodate bill (which is huge) is paid by our IT department.

Penny Marsala, MA, MLIS
Sr. Manager; Medical Librarian
Arneson Methodist Library
Park Nicollet Institute
[log in to unmask]

Our hospital is smaller than yours, but it is also a teaching hospital with a basic sciences research center and one small degree program.  Our Medical Staff office pays for UpToDate, as it has been integrated with our EMR system.  I have seen horror stories of hospital libraries basically becoming nothing more than a provider of UpToDate because price increases wipe out the budget for other resources.  One hospital that I know of is down to 10 journal subscriptions, which is too few to allow them even to participate in Docline.

Thomas B. Craig, MSLS
Director of Library Services
Watson W. Wise Medical Research Library
The University of Texas Health Science Center at Tyler / UT Health Northeast
phone: 903-877-2864

We are a 420-bed community hospital. This is our first year resigning UTD as an institutional subscription (we've had individual subs for years) and it is basically in my budget, because I am part of Medical Staff Services and that is who is paying for it; plus, I am the go-to person, now, for questions and contact for UTD, so it made sense to keep it within the Library/MSS budget. We'll see what happens a few years down the road :)

IMO, I think the Medical Staff should pay for it, as they are the ones who want it and use it. I've never really understood how/why resources of this nature get into IT dept budgets. But, that's just me...

Mollie W. Titus, MLIS
Medical Library & Community Health Information Center Self Regional Healthcare (SCUGRW)
1325 Spring Street
Greenwood, SC  29646
Tel. 864-725-4851 or 4797; Fax 864-725-4838 [log in to unmask]

The library's budget is under Dept of Medical Education which is under Chief Medical Officer of medicine and all medical specialties

Catherine Moore
Health Sciences Library (MAUBHA)
Signature Healthcare Brockton Hospital
680 Centre Street
Brockton MA 02302-3308
[log in to unmask]

The Medical Library, part of Medical Education.
Kathy Zeblisky, MLS, AHIP
Medical Library Manager
Phoenix Children's Hospital
p (602) 933-4248 | f (602) 933-4249
Hours: M-F 7:00 am to 3:30 pm
 [log in to unmask]

Here at GH, the library is responsible for the UTD invoice, which I prefer.  My belief is whomever is responsible for the invoice has the power.

Katherine Stemmer Frumento
Director, Library Services
Greenwich Hospital
5 Perryridge Rd.
Greenwich, CT 06830
(203) 863-3285
mailto:[log in to unmask]

We are a 230 bed community hospital. We offer Uptodate w/in the hospital only. The cost is split between the library and the medical staff / the library managing the subscription. If a doctor wants remote access, they must pay for it individually.
Hope this helps!

Janie Kaplan
Northern Westchester hospital
Mt. Kisco, NY
Sent from my iPhone

In our hospital, the CIO in Information Services pays for UptoDate.  The library couldn't afford it and bought DynaMed, but some doctor or doctors with clout/influence asked IS to get it.  This actually pre-dated my time as Manager of Library Services.  I have been angling to get the library involved in all decisions about purchases of knowledge-based information resources ever since, but there are cultural reasons why various doctors and others go off in all directions and purchase educational software, information resources, and other resources without coordinating with the institution as a whole.  I am on a hospital steering committee that is working to change that culture and we are making some progress.  In the meantime, the library has become a lot more central to providing online knowledge-based information resources and to teaching people how to use them, so it has become much more natural for individuals who want a new product to approach us first.  It has been harder to get the money to take over existing contracts or enter into new ones.  Rome was not built in a day.

Brenda Pfannenstiel
Medical Librarian

The library does NOT pay for it. Some areas of the institution have purchased for selected students.

Margaret Vugrin, MSLS, AHIP
Reference Librarian
Texas Tech University Health Sciences Library
3601 4th, MS7781
Lubbock, TX 79430
[log in to unmask]
P 806-743-2241
F 806-743-2218

We are a 410 licensed bed(280 staffed)community, non-teaching hospital.  Our institution does not subscribe.  However, some individuals in departments/clinics have a personal subscription which I suspect they are probably sharing amongst themselves.  I don't know for sure, but I have informed them that it is not legal to share a personal subscription.  If I were to find out for sure that they are sharing, I'd probably need to report it to our compliance office (to cover myself.)  I also don't know if the personal subscriptions are being paid for by the hospital or by the person themselves.  

I also work in the medical library of another nearby hospital (150 beds, community, non-teaching).  They do not subscribe.  The Med Staff has asked the library to subscribe but we can't afford it.

Donna J. Winkelman, BS, MLS
Manager, Health Sciences Resource Center/CME Glens Falls Hospital 100 Park Street Glens Falls, NY 12801 518-926-1850 FAX 518-926-1851 [log in to unmask]

Our library paid for UptoDate when it was on a single workstation CDROM, but when UptoDate switched to online only then my previous director told our administration that we could not afford the institutional online subscription (it would have taken almost our entire library budget), so if they wanted it they would have to pay for it.  The end result is that we manage it just like we do all the other online databases, but it is paid for by the medical affairs administration.  There is sticker shock this year since the specialties have increased and PAs, NPs and III-IV year medical students are being included in the clinician count, but as far as I know they are still going to pay for it!

Janet S. Bolduc, MSLS
Library Director
Gerrish-True Health Sciences Library
Central Maine Medical Center
300 Main Street
Lewiston, ME  04240
Fax: 207-795-2569
[log in to unmask]

It's paid by the library, but we get a generous donation from the medical staff annually.  It's not specifically for UTD, it's not restricted in any way.

Madeleine M. Taylor, MLS, MA
Medical Librarian
Health Sciences Library
St. Joseph's Regional Medical Center
703 Main Street
Paterson, NJ 07503
Voice 973-754-3590
Fax 973-754-3593
Email  library @
Hospital Website:

I bet there is big sticker shock for people seeing UTD cost for the first time! I was even shocked.

At my hospital, a similar 500 bed not-for-profit community hospital, IT and MedicalStaff paid for UTD and MDConsult up until 3 years ago.  At that time, funds and payment transitioned to the library budget, which makes perfect sense because I deal with vendors, contracts and payments for all other databases, online journals & books, etc.

I wholeheartedly agree with another librarian who posted "My belief is whomever is responsible for the invoice has the power."

Lynne Ferrell,  MSLIS │ Librarian & Archivist Schnepp Professional Library │HR Operations Memorial Health System│701 North First Street│Springfield, IL 62781
S: 217.788.3331│: 217.788.5540│: 6048││: [log in to unmask]

We pay for it out of the Medical Library budget.  Medical Library reports directly to Administration.
We are separate from IT and Medical Staff.  We are a 200-bed community hospital.
Someone on the Medlib-L listserve said something about “power because of handling the UTD subscription” and oddly enough, I’d have to agree with that.  Handing UTD has been the Medical Library’s biggest visibility along with further justification for services.
We also had major sticker shock because UTD increased their price to us by an 511% increase.  (We’ve been their customers since the early 2000’s.)  We were able to negotiate it down to 30% increase, and have locked in multi-years step-up pricing agreement with their UTD Anywhere license.  So, while the funds comes out of the Medical Library budget, I have full awareness of this by our Administration, along with our Materials Management Director doing the negotiations for us.  He says in his many years of negotiations with a wide variety of hospital vendors, UTD is the worst one he’s ever had to deal with; and our Administration knows that.  Based on a survey of all physicians in late 2013, our collective physicians are divided regarding having access to UTD knowing their true price.
Heidi Sue Adams, MS, AHIP(D) | Lead Medical Librarian | (406) 752-1739 | [log in to unmask] | DOCLINE: MTUKRH |
Kalispell Regional Medical Center | Medical Library | 310 Sunnyview Lane | Kalispell MT 59901 | 
With our help, you can provide excellent patient care using the latest medical information - Rachel, Laurie, Heidi Sue @ KRMC Medical Library  

The medical library budget pays for UTD here.  We are a teaching hospital, about 250 beds.

Catherine Guarcello, MS
Director, Stohlman Library
St. Elizabeth’s Medical Center
736 Cambridge St.
Boston, MA  02135
617-789-2177 voice
617-789-5081 fax
[log in to unmask]

It comes out of the library's budget at Fox Chase Cancer Center. Fccc is a cancer research institute and a specialty cancer hospital ( NCI-designated).


Our library budget covers annual subsription for UpToDate, as it does for most other electronic resources used by our hospital and allied health staff.

Maryann Cowgill  I  Medical Librarian  I  Wairarapa District Health  I Blair Street I Masterton 5840, New Zealand I t 06 9469800 x5203 I [log in to unmask]  

We are a 700+ bed teaching hospital and our IT department pays for the UpToDate subscription.

Alexandra Short, MSLS, AHIP
Director, Library Services  |  484-628-8418 [log in to unmask]<mailto:[log in to unmask]>  |

In our case funding is coming from two fund raising bodies associated with our health service district. We promote their support and in turn they pay the (substantial) invoice Thanks, Rob Nambour General HospitalAustralia