It is hard to think that there would be competition in the "love to hate" vendor category, but UpToDate seems to draw more fire and bitter words among librarians than even the traditionally criticized Elsevier Science. So is it a surprise that another librarian is sounding off on MEDLIB about UTD's rather heavy handed and callous business practices?

Come renewal time, UTD called a librarian and questioned the accuracy of the hospital supplied statistics in the American Hospital Association Guide (UTD bases its costs on those statistics) and UTD demanded an extra $10,000 because 27 part time physicians in two satellite research facilities (that don't see patients) technically have access on the same hospital computer network. So this librarian and her hospital must either fork over an extra $10K for these 27 doctors to have access at their research offices or she along with her IT department must determine a way to prevent those research offices from accessing UTD. Thus, create the unequal access to institutional resources situation where the librarian says, "a doc standing on our main campus can use UTD, but when she's standing in her research office she can't." The librarian discovered at the end of her conversations with UTD that her hospital's usage was "three times greater than other hospitals of our type, implying that either there was some kind of malfeasance going on, or that we must be prepared to pay for our crime of actually using their product." I guess UTD believes those 27 part time research physicians are really responsible for the large usage, or the hospital is lying to the American Hospital Association by downplaying their statistics in an effort to get better UTD pricing.

So why not collaborate and try collective bargaining? Many librarians (including myself) have noticed that UTD is rather apathetic or outright dismissive of consortia agreements and pricing. One librarian's opinion was that UTD doesn't even want institutional pricing, citing that her hospital's institutional price jumped up by $22,000 in one year forcing her hospital not to renew. When she told the national sales manager they were not renewing, her response was simply, "Really. All right. Goodbye." Doctors, librarians, and hospital administrators who want off campus access to UTD are most likely in for a sticker shock. A librarian shared that the quote for her hospital's UTD access was $24,000 for on campus access and $262,000 for remote access (almost 11x's more expensive).

Many other librarians expressed similar frustrating stories and mentioned that when push came to shove they had to choose (for financial reasons and for restrictive access reasons) other competing products. DynaMed, FIRSTConsult, eMedicine, among others were all mentioned as possible alternatives to UTD. David Rothman recommended two links, http://listserv.buffalo.edu/cgi-bin/wa?A2=ind0511B&L=MEDLIB-L&P=R1715&I=-3 and http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1175815 (on DynaMed), and Ellen Westlin recommended http://ils.mdacc.tmc.edu/papers.html as resources for librarians to evaluate point of care tools and other products similar to UTD.

In my October 20, 2005 post "Are there adequate alternatives to UpToDate" I listed Denison's comparison chart of eMedicine, FirstConsult and UTD and I asked why doctors love UpToDate so much? It almost seems that they are blind to a fault on UpToDate's shortcomings. Shortcomings such as: prohibitive off campus access restrictions, no institutional handheld applications, still not integrated with an EMR, not technically Evidence Based information, and the fewest number of medical specialties covered (16, three of which are in development) compared to its competitors.

So despite the doctors' love for UpToDate are we coming upon a time when hospitals are saying enough is enough and choosing to force doctors to use another product other than UTD? If so are doctors concerned? If they are concerned are they communicating their concerns to UpToDate? Or does UTD treat them with the same disdain and apathy as they seem to treat hospital administrators, IT, and librarians? As a librarian I am wondering when their business practices will catch up to their bottom line, because until it does we will not see a change from them.