As medical libraries are increasingly providing information in electronic format and simultaneously dealing with budget cuts, there is a need to analyze the usage of print and electronic titles being purchased. This study takes place at an academic medical center library and attempts to gather and analyze data from a variety of sources that may influence future print and electronic monograph purchasing decisions. Purchases were broken down by subject and compared against one another in terms of average numbers of loans. Five subject areas were chosen for further, title by title analysis to determine what types of titles circulated more frequently than others. Ultimately, the library wishes to ensure that the materials it selects are the ones that are needed and used, thereby providing the best return on investment for its book dollars while keeping the patrons satisfied with the quality of the collection. A balanced scorecard approach is employed to set goals for increasing circulation of purchased monographs