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January 28, 2015
By Jennifer McCartney
Two college professors self-published an affordable, easily updated, and popular textbook.

Bob Hoyt, an instructor and director of the Health Informatics program at the University of West Florida, knew his students were struggling with the high cost of their textbooks. The nominal price of college textbooks has “risen more than fifteenfold” since 1970 -- which is three times the rate of inflation -- according to a recent article in the Economist, while the Wall Street Journal notes the cost of new print textbooks has risen, on average, about 6% a year for the last decade. Hoyt was also frustrated that new developments in his field meant information in the books was already obsolete by the time they were published. “There were no textbooks that were up to date or easy to read,” Hoyt says. To solve the problem, he decided to create his own, with associate editor and adjunct instructor at the University of West Florida Ann Yoshihashi, and self-publish it on -- and sell it for about a third of the cost of a regular textbook.

Seven years later, Health Informatics: Practical Guide for Healthcare and Information Technology Professionals (about using IT to improve health care) is in its sixth edition and is taught at more than 200 universities in 30 countries. The book has sold about 12,000 copies and has been endorsed by the American Medical Informatics Association. While the sales figures don’t come close to the stratospheric success usually associated with self-publishing success stories, there are signs that self-published textbooks could be the start of a new trend with the potential to upend the $7 billion college-textbook industry.

The Rise of Content Entrepreneurs

While something titled Health Informatics: Practical Guide for Healthcare and Information Technology Professionals might not seem a likely candidate for a successful self-publishing venture, Lulu President and CEO Tom Bright says it’s precisely authors like Hoyt and Yoshihashi—authors he calls “content entrepreneurs”—that are leading the next successful wave in self-publishing. Bright notes that content entrepreneurs are primarily business owners or professionals—people for whom writing isn’t their primary career.

"You don't have this type of control with traditional publishers."
Bright says authors of this sort sell 20 times as many books on Lulu as fiction writers do. “We’ve found that top nonfiction and education books generate 24% more net sales per title than top books in other genres,” he adds. To be considered a content entrepreneur, authors must see 50% or more of their sales from third-party purchases in addition to having over 500 visits to their book or author spotlight pages from an outside referral source.

“When we see a trend within our own author base that we feel it is important for the publishing world to know, we want to share the data,” says Bright. The company, founded in 2002, and which has recently expanded its relationship with Ingram to Include Amazon's Kindle and Kobo e-book distribution, is seeing more and more of its success stories originate with content entrepreneurs, Bright notes.

The Self-Publishing Professors

Despite the initial success with the first edition of Health Informatics in 2007, the self-publishing process wasn’t always easy.  Hoyt, an internal medicine physician, and Yoshihashi, an endocrinologist, wrote the book primarily for those seeking employment in the rapidly growing health-care industry—an audience that includes physicians, dentists, nurses, and Hoyt’s students studying health information management. “As health care becomes more automated and digitized, there has been tremendous interest in this field,” he says. But, despite their credentials, the two U.S.  Navy veterans decided to skip traditional publishing and self-publish the volume.

“Initially we received some criticism regarding why we chose to go this route because all of the other similar textbooks used traditional publishers,” Hoyt notes.

But Yoshihashi had done her research and determined that self-publishing held a number of advantages for them over traditional publishing. These advantages included the fact that they were able to keep a larger share of the profits, the ability to control the price of the book, the quick turnaround time from submission to publication, and the ease with which they could update the book and republish it. “We also can say when we would like older editions to be no longer printed. You don't have this type of control with traditional publishers,” he notes.

As for their initial critics, Hoyt says, “we have had the last laugh because students can find articles written in January 2014 in our book published that same month.” The sixth edition, most recently updated in July 2014, reflects the most recent changes in technology, policies, and innovations that have occurred in the informatics field, he notes.

Affordability Is Key

Hoyt feels that the rising cost of college textbooks has helped their affordably priced volume become so successful.  With the Kindle edition priced at $32.95 and the print edition at $69.95, the book is considerably less expensive in both formats than most textbooks available for purchase. Hoyt says his students appreciate that he took pricing into consideration when self-publishing: “They can buy a chapter at a time so they don’t have to buy the entire textbook if they don’t need it. This, he notes, “is very important given the financial burden to students and burgeoning textbook prices.” And while renting textbooks has become a popular option for students who can’t commit to purchasing the book, Hoyt notes that buying their textbook in e-book format is actually cheaper than renting it.

But, even with this competitive pricing, the profits add up quickly—Lulu authors keep 80% of the income from print sales and 90% of digital sales. With the proceeds generated from the sale of the volume, the authors have donated more than $100,000 to the University of West Florida and established grants of more than $25,000 to support health informatics educational programs. Self-publishing, Hoyt says, let them control the price of the book to get ahead of the competition while keeping costs low for their students.

The Challenges of an Indie Textbook

Hoyt and Yoshihashi found that the biggest publishing challenge was formatting the massive manuscript in Microsoft Word. “When your work is over 500 pages that includes images, tables, etc., in each chapter, we spend an inordinate amount of time trying to manage formatting,” he says. He admits Microsoft Word might not be the best option for a project of that size and says they’re looking into alternatives.

The addition of multiple authors and contributors adds another layer of complexity. “It can be very challenging to get busy people to stick to a deadline,” says Hoyt. For the extensive index they used a program called TExtract and did all the editing themselves.

The final challenge was converting the document with its multiple images and graphs into an ePub file—a complicated process. “You can have a draft copy of the textbook printed and shipped to your house or work in just days”—a process that Hoyt says lets the author retain complete control over the final product. “We have to have it printed out multiple times to be sure it is right,” Hoyt says. “This process takes weeks after the book seems to be in the final draft.”

Additionally, a student at the University of West Florida designed the book cover for them and each new edition comes in a different color to differentiate it from the last.

While Hoyt admits that the final product “is not quite as polished as what you would receive from a traditional publisher,” he believes the advantages of their self-published edition outweigh the negatives. 


Hoyt and Yoshihashi started a website to support the textbook. They offer free copies of Health Informatics to instructors—a practice that he believes has helped with adoption at universities. “There is an option for faculty who want to use our textbook to download a PDF version of the book, plus an instructor's manual and PowerPoint slides,” he explains. He also advises authors to make it easy for readers to contact them and to ensure there’s a free download sample for readers to give the book a trial run. The feedback they get about the book via their website is critical, Hoyt says, especially as they are publishing in a rapidly evolving category. “It may take you more than one edition to include the most important content,” he notes.

Using the service MailChimp, the authors also send out a newsletter containing all the latest updates to the book. “We highly recommend an electronic newsletter,” he says. “We did not choose to go the Facebook or Twitter route, but they are also possible alternatives to promote the book.”

While Lulu handles the majority of book sales and shipping, Hoyt notes that authors have control over the price and are able to give discounts for conferences and special occasions.

‘The Rest Is Gravy’

“One of the many beauties of self-publishing is that each individual sets their own parameters for success,” says Bright. In Hoyt and Yoshihashi’s case, they say they never expected to generate such substantial proceeds from the sale of their book—and plan to continue to donate the funds to grant programs furthering education in the health informatics field.

“Once you get over the initial concern that you are not using a traditional publisher, the rest is gravy,” Hoyt says. “Readers will quickly understand why you self-published and they will no longer criticize, but, instead, they will praise the process.”