Paid Clinical References & Licensed Datasets

The commercial counterpart to our free public-sector and standardized-vocabulary maps. This catalogs the paid clinical-reference products and licensed research datasets that a pediatric DPC EMR like Starlight Practice would either license, evaluate-then-substitute, or skip outright.

Pricing transparency

Most of this market is "contact sales" — published list prices are rare. Numbers below are either (a) publicly listed, (b) widely reported in the trade press / library procurement records, or (c) industry-known ballparks from EHR vendor licensing experience. Treat all dollar figures as approximate and always negotiate.

License re-use is the load-bearing question

Almost every vendor on this page prohibits ingestion into LLM training/RAG context without a separate, expensive AI-rights addendum. Read the "License re-use" row before assuming we can ground GPT/Claude on this content. This is the single biggest constraint on Starlight's AI-substrate architecture.

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1. Tier-1 Clinical References

The "every practice considers one of these" tier. Pick at most one as the primary; the others are evaluation-and-substitute candidates.

UpToDate (Wolters Kluwer)

• One-liner: The dominant point-of-care clinical reference; ~12,000 graded topics, peer-reviewed, with explicit recommendations and graded evidence. The de facto industry standard.
• URL: uptodate.com
• Pricing (approximate, 2026):
  • Individual physician: ~$559/yr (UpToDate Core), ~$629/yr (Pro), ~$729/yr (Pro Suite incl. Lexidrug).
  • Resident/fellow/student: ~$199/yr.
  • Group practice: ~$450–500/clinician/yr at modest volume; declining with size.
  • Hospital/enterprise: site-licensed, typically $30K–$500K+/yr depending on FTE count.
  • Many academic affiliates get it free via the institution.
• Access mechanism: Web, mobile app, EHR integration via UpToDate Smart Search (Epic, Cerner/Oracle, Athena, Meditech). A formal UpToDate API / EHR integration program exists but is gated to enterprise contracts.
• License re-use: Subscriber license is strictly read-only at the point of care. No ingestion into LLM context, no caching, no verbatim display outside of authenticated UpToDate UI. Wolters Kluwer has been aggressive about enforcing this against AI startups. A separate "AI Rights" license exists but is enterprise-priced (mid six figures+).
• Pediatric depth: Strong. Hundreds of peds topics, peds-specific dosing in Lexidrug bundle. Not as deep as Nelson's for rare disease but covers 95% of DPC needs.
• Substitution path: OpenEvidence + MedlinePlus + AAFP + PubMed/MEDLINE + NCBI Bookshelf (Nelson Essentials chapters partially free) covers ~70% of UpToDate value. Bright Futures + AAP free guidelines covers most well-child territory.
• Recommended posture: License-after-product-market-fit. Day-one Starlight should ground on free sources + OpenEvidence-for-physicians; add UpToDate when a clinician explicitly demands it and we can justify $500–700 per seat.

DynaMed (EBSCO)

• One-liner: Evidence-based point-of-care reference; tighter editorial process, stronger explicit grading than UpToDate; smaller market share.
• URL: dynamed.com
• Pricing (approximate):
  • Individual: ~$399–$495/yr (often discounted to $299 for AAFP/ACP members).
  • Hospital site license: typically 30–50% cheaper than UpToDate at comparable FTE counts.
  • Bundled with Dynamic Health (nursing) and DynaMed Decisions (shared decision-making tools).
• Access mechanism: Web, mobile, EHR integration (Epic, Cerner, Athena). API exists for institutional partners.
• License re-use: Same posture as UpToDate — read-only point-of-care use; no LLM ingestion without a negotiated AI addendum.
• Pediatric depth: Good but thinner than UpToDate. Adequate for general peds DPC.
• Substitution path: Same as UpToDate.
• Recommended posture: Evaluate-but-likely-substitute unless we land a customer who already has DynaMed institutional access.

ClinicalKey (Elsevier)

• One-liner: Massive content aggregator — full-text Elsevier journals, books (incl. Nelson's), drug monographs, MEDLINE, procedure videos, patient-ed handouts. Less a point-of-care tool, more a research desk.
• URL: clinicalkey.com
• Pricing:
  • Individual: ~$499/yr (ClinicalKey).
  • ClinicalKey for Nursing, ClinicalKey AI, and ClinicalKey for Students are separate SKUs.
  • Institutional: contact sales — typically $20K–$300K+/yr depending on title bundle and FTE.
• Access mechanism: Web; EHR integration via context-launch (no first-class API for content ingestion).
• License re-use: Highly restrictive — content is third-party publisher material; no AI training, no RAG ingestion without a custom "ClinicalKey AI" license. Elsevier is the most litigious publisher in this list.
• Pediatric depth: Excellent for reference depth because Nelson's lives here. Weaker as point-of-care guidance.
• Substitution path: PubMed Central + NCBI Bookshelf for free full-text peds chapters; AAP for guidelines.
• Recommended posture: Skip unless a customer's existing institutional license covers it. Elsevier's terms are the worst for an AI-substrate platform.

BMJ Best Practice

• One-liner: UK-rooted point-of-care reference; strong primary-care focus; cleaner UI than UpToDate, smaller US footprint.
• URL: bestpractice.bmj.com
• Pricing:
  • Individual: ~$299/yr.
  • Free/discounted via many academic and government affiliations (e.g., NHS, AAFP).
  • Group/site: contact sales; generally cheapest of the Tier-1 options.
• Access mechanism: Web, mobile, EHR context-launch; XML feed available for institutional partners.
• License re-use: Read-only; no LLM ingestion without negotiated terms. BMJ is somewhat more open to research partnerships than Elsevier/Wolters Kluwer.
• Pediatric depth: Reasonable. Strong on common pediatric conditions, weaker on US-specific guidance (immunization schedules differ slightly).
• Substitution path: Same as UpToDate.
• Recommended posture: Evaluate-but-likely-substitute. Best price-per-feature in the Tier-1 group; could be a differentiator if we partner with a UK/AU/CA pediatric DPC market.

AMBOSS

• One-liner: Originally a USMLE/board-prep platform; increasingly used as a clinical reference and CDS tool. Strong cross-linking, very popular with residents.
• URL: amboss.com
• Pricing:
  • Clinician (post-residency): ~$199/yr (Knowledge), ~$399/yr (Pro/CDS).
  • Resident: ~$129/yr.
  • AMBOSS Clinic / for Hospitals: contact sales.
• Access mechanism: Web, mobile, browser extension that overlays clinical sites. AMBOSS for Hospitals offers EHR context-launch.
• License re-use: Read-only; AMBOSS has been more public about AI partnerships than incumbents but still requires a separate license for training/RAG.
• Pediatric depth: Solid for board-relevant peds; less deep on rare disease.
• Substitution path: Free clinical references + Wikipedia-medicine (surprisingly good) + OpenEvidence cover most of AMBOSS's reference value.
• Recommended posture: Evaluate — the cheapest Tier-1 alternative; the modern UI plays well with younger clinicians. Worth a pilot if we want to layer "study/teach" features in Starlight.

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2. Pediatric-Specific References

Lexicomp Pediatric & Neonatal (Wolters Kluwer)

• One-liner: The pediatric drug-dosing reference. Weight-based dosing, neonatal adjustments, IV compatibility. If we do peds prescribing, this is the gold standard.
• URL: wolterskluwer.com/en/solutions/lexicomp
• Pricing:
  • Individual peds clinician: ~$285/yr (Lexidrug Pediatric & Neonatal app).
  • Bundled in UpToDate Pro Suite (above) — best value if we already license UpToDate.
  • EMR-integration feed (drug content for CDS): enterprise contract, typically $50K–$500K+/yr depending on practice count.
• Access mechanism: Mobile app, web, EMR drug-content integration (this is where the real cost lives).
• License re-use: Drug-content feeds licensed to EMRs are governed by per-practice / per-prescriber royalty terms. Cannot re-distribute or expose via public API.
• Pediatric depth: Best in class.
• Substitution path: RxNorm + DailyMed + FDA Pediatric Labeling Database are free and cover ~60% of dosing needs but are dramatically less curated. Harriet Lane as a backup.
• Recommended posture: License-from-day-one if we are doing pediatric e-prescribing with allergy/interaction checking. The clinical-safety risk of getting peds dosing wrong is too high to substitute.

Micromedex (Merative, formerly IBM Watson Health)

• One-liner: Comprehensive drug reference — Lexicomp's main competitor. Strong on drug interactions, IV compatibility, toxicology (Poisindex).
• URL: merative.com/clinical-decision-support
• Pricing: Individual ~$295/yr; institutional/EMR feed contracts in the same range as Lexicomp.
• Access mechanism: Web, mobile, EMR drug-content integration, Micromedex API (institutional).
• License re-use: Same as Lexicomp.
• Pediatric depth: Strong (NeoFax neonatal, Pediatric & Neonatal Lexi-Drugs equivalent).
• Substitution path: Same as Lexicomp.
• Recommended posture: Evaluate as alternative to Lexicomp. Pick one; both are too expensive to license simultaneously.

Harriet Lane Handbook (Johns Hopkins / Elsevier)

• One-liner: The pediatric resident's pocket bible. Dosing, common conditions, procedure references. Available as book + paid mobile app.
• URL: elsevier.com/books-and-journals/book-companion/9780323876988
• Pricing: Book ~$60; mobile app via Unbound Medicine ~$80/yr.
• Access mechanism: Book + app; no API.
• License re-use: Book/app license — no ingestion.
• Pediatric depth: Excellent breadth, less deep than Nelson's.
• Substitution path: Bright Futures + AAP guidelines + RxNorm for the dosing pieces.
• Recommended posture: License for the practice (cheap clinician benefit), don't ingest.

Nelson's Textbook of Pediatrics (Elsevier)

• One-liner: The encyclopedic pediatrics textbook — the reference of last resort for unusual presentations.
• URL: elsevier.com/books/nelson-textbook-of-pediatrics
• Pricing: Book ~$280; full-text access via ClinicalKey (above).
• License re-use: Strict Elsevier terms; no ingestion.
• Recommended posture: License via ClinicalKey only if institutional; otherwise skip.

AAP Red Book (Pediatric Infectious Disease)

• One-liner: The AAP's authoritative pediatric ID reference, updated every 3 years. Required reading for vaccine schedules & ID management.
• URL: redbook.solutions.aap.org
• Pricing: Book ~$200/edition; Red Book Online ~$170/yr individual; institutional licensing available.
• Access mechanism: Web; AAP eBooks; no general API.
• License re-use: Members may use clinically; no ingestion without AAP's permission.
• Pediatric depth: Definitive for pediatric ID + immunization.
• Substitution path: CDC ACIP recommendations are free and cover immunizations very well. Red Book adds depth on rare ID and clinical management of cases.
• Recommended posture: License-after-PMF for the practice; pre-PMF rely on free CDC + AAP guidelines.

AAP Bright Futures Tool & Resource Kit (paid edition)

• One-liner: The well-child-visit operationalization of the (free) Bright Futures Guidelines — forms, handouts, parent-ed materials, screening templates.
• URL: brightfutures.aap.org
• Pricing: Tool & Resource Kit ~$200–$300; institutional licenses ~$1K–$5K.
• Access mechanism: PDFs, forms; no API.
• License re-use: Limited reproduction rights for in-practice use. Cannot redistribute as part of a SaaS. Cannot ingest into general LLM context.
• Pediatric depth: Core operating system for well-child visits.
• Substitution path: Free Bright Futures Guidelines PDFs cover ~80% of the content.
• Recommended posture: License-from-day-one. This is the well-child checklist Starlight will operationalize; the paid kit's forms/handouts save months of design work.

AAP Pediatric Care Online (PCO)

• One-liner: AAP's point-of-care pediatric reference — bundles Red Book, Bright Futures, Pediatric Patient Education, AAP Quick Reference Guides.
• URL: publications.aap.org/pediatriccare
• Pricing: Individual member ~$249/yr; non-member ~$349/yr; institutional contact sales.
• Access mechanism: Web; some EHR partner integrations.
• License re-use: AAP terms; no LLM ingestion.
• Pediatric depth: Best AAP-curated peds bundle.
• Substitution path: Free Bright Futures + free CDC ACIP + AAP free practice resources cover most of it.
• Recommended posture: License-after-PMF. Strong clinician-recruiting value; not architecture-critical.

Pediatric Care Compendium / Specialty Subscriptions

• Various publishers (e.g., Elsevier Pediatric Clinics of North America, AAP Pediatrics in Review, Hopkins Pediatric Clinics).
• Pricing: $150–$400/yr each.
• Recommended posture: License individual journals as clinician-perk benefits, don't ingest.

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3. Drug Interaction & Decision-Support Content

This is the most important paid-content category for an EMR. Drug-drug interaction (DDI), drug-allergy, dose-range, duplicate-therapy, and drug-pregnancy alerts are required for safe e-prescribing. You license one of the four "big" databases as a structured feed and build CDS on top.

First Databank (FDB) MedKnowledge

• One-liner: The most-licensed structured drug database in US EMRs. Powers the majority of ambulatory EHR drug screens.
• URL: fdbhealth.com
• Pricing: Contact sales. Industry-known ballpark: $50K–$150K/yr base for a small EMR vendor + per-prescriber royalties (rough range $10–$50/prescriber/yr) at scale. Pediatric module is incremental.
• Access mechanism: Structured data feed (XML/JSON) under license; refresh weekly. SDK + cloud APIs (FDB Cloud Connector) available.
• License re-use: Embed in CDS for licensed users only. No public API exposure, no AI training, no caching beyond the licensed instance. Per-prescriber-counted.
• Pediatric depth: Strong; pediatric-specific dosing modules available as add-ons.
• Substitution path: RxNorm + DailyMed + NLM RxNav (DDI) is free but vastly less complete for clinical-grade alerts. Acceptable for MVP, not for production prescribing.
• Recommended posture: License-from-day-one once we are e-prescribing. Pre-prescribing MVP can use RxNav.

Wolters Kluwer Medi-Span

• One-liner: FDB's primary competitor. Comparable structured drug database; bundled with Lexicomp content under WK.
• URL: wolterskluwer.com/en/solutions/medi-span
• Pricing: Same ballpark as FDB. Bundled discounts if licensing UpToDate + Lexicomp.
• Access mechanism: Structured feed, refresh weekly, APIs available.
• License re-use: Same as FDB.
• Pediatric depth: Strong (Lexi-Drugs Pediatric integrated).
• Recommended posture: Evaluate vs. FDB. If we end up licensing UpToDate + Lexicomp, the Medi-Span bundle is the path of least resistance.

Multum (Cerner Multum / Oracle Health)

• One-liner: Drug content originally licensed to consumer-facing properties (Drugs.com, WebMD); now under Oracle Health.
• URL: Bundled with Oracle Health
• Pricing: Generally only available bundled with Oracle Health products.
• License re-use: Cerner/Oracle terms.
• Recommended posture: Skip unless we go all-in on Oracle Health.

Truven / Micromedex (Merative)

• One-liner: Same brand family as the reference (above), with structured drug-database feeds for EMR CDS.
• Pricing: Same range as FDB / Medi-Span.
• Recommended posture: Evaluate as a third option, especially strong if we want toxicology (Poisindex) bundled.

Lexi-Drugs (Wolters Kluwer)

• One-liner: The clinician-facing UI on top of Medi-Span. If we license Medi-Span as a feed, Lexi-Drugs is the read-side companion.
• Recommended posture: License with Medi-Span if we go that route.

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4. Code-Set Licensing

The categories where licensing is not optional if we want to bill US health plans, document mental health, or work outside the US.

CPT (American Medical Association)

• One-liner: Procedure billing codes. Required for US claims to commercial & CMS payers. AMA owns and aggressively licenses.
• URL: ama-assn.org/practice-management/cpt
• Pricing:
  • Data files (XML, distribution license): $500–$5,000/yr for small developers, up to $50K+/yr at scale, plus per-end-user royalties.
  • Per-end-user (clinician/biller) royalties: industry-known ~$5–$20/user/yr depending on volume.
  • Vendor program: AMA's "CPT Distribution License" required for any software that displays or operates on CPT codes — includes audit rights.
  • Books: ~$130/yr (CPT Professional Edition).
• Access mechanism: XML/CSV downloads under license; no public API.
• License re-use: Display only to licensed end-users; no public exposure of CPT codes; no LLM ingestion. This is one of the most aggressively enforced licenses in healthcare IT.
• Recommended posture: License-from-day-one. Non-negotiable for US billing. Budget ~$5K–$25K/yr in early years.

SNOMED CT International

• One-liner: Comprehensive clinical terminology. Free in the US (NLM-funded); paid abroad through SNOMED International member-state licensing.
• URL: snomed.org
• Pricing: Free in US via UMLS. International: country-by-country. Non-member-country commercial use: ~$1,000–$50,000+/yr scaling with revenue and use.
• License re-use: Affiliate License governs all use; redistribution restricted; AI use is permitted under the affiliate terms but derivative works must be tracked.
• Recommended posture: Free in US (license-from-day-one via UMLS); defer international until we expand outside the US.

DSM-5-TR (American Psychiatric Association)

• One-liner: Mental health diagnostic criteria. Required if we document mental-health diagnoses with full criteria (vs. just ICD-10 codes).
• URL: psychiatry.org/dsm5
• Pricing:
  • Book: ~$160.
  • Digital integration license: contact APA Publishing. Industry-known ballpark for EMR integration: $10K–$100K+/yr depending on user count and what we display (codes only vs. full criteria).
• License re-use: Codes are usable freely; the diagnostic criteria text is copyrighted and requires APA license to reproduce. No LLM ingestion of criteria text without license.
• Pediatric depth: Adequate (autism, ADHD, anxiety, depression criteria all peds-relevant).
• Substitution path: ICD-10-CM codes for mental-health diagnoses are free; we can document the diagnosis without reproducing DSM criteria text.
• Recommended posture: Skip the digital license; use ICD-10 codes only and refer clinicians to their own DSM book. License only if a customer specifically demands integrated DSM criteria.

CDT (American Dental Association)

• One-liner: Current Dental Terminology — billing codes for dental procedures.
• URL: ada.org/publications/cdt
• Pricing: Books ~$70; digital/EMR distribution licensing contact ADA, generally cheaper than CPT but same model. Industry-known ballpark $2K–$20K/yr + per-user royalties.
• License re-use: Same posture as CPT.
• Recommended posture: Skip until dentistry is on the roadmap. Per the auxiliary bets section, defer to Phase 2+.

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5. Imaging & Lab Content (Paid)

Primal Pictures (Informa)

• One-liner: 3D anatomy atlas — the most-licensed anatomy product in medical schools.
• URL: primalpictures.com
• Pricing: Individual ~$199/yr; institutional ~$5K–$50K/yr.
• License re-use: Strict — no embedding outside the licensed UI.
• Recommended posture: Skip. Not core to DPC peds.

STATdx (Elsevier)

• One-liner: Radiology decision support — the radiologist's UpToDate. Useless for non-radiology DPC.
• Recommended posture: Skip.

VisualDx

• One-liner: Image-driven differential-diagnosis tool, especially strong on pediatric dermatology and rashes. Genuinely useful for peds DPC.
• URL: visualdx.com
• Pricing: Individual ~$399/yr; group/practice contact sales.
• Access mechanism: Web, mobile, EHR context-launch, VisualDx API (institutional).
• License re-use: Read-only; image library strictly licensed, no AI training.
• Pediatric depth: Excellent (one of the few peds-strong commercial sources here).
• Substitution path: DermNet NZ is free and good but less curated; AAP image library partial.
• Recommended posture: License-after-PMF. This is one of the few paid sources whose UX a peds clinician would actively miss.

Lab Tests Online / Testing.com

• One-liner: Patient-facing lab-test reference. Free. (Flagged here so we don't budget for it.)
• URL: testing.com
• Recommended posture: Use freely, attribute properly. Good source for parent-app lab-result explanations.

ARUP Consult

• One-liner: Lab-test selection & interpretation guide from ARUP Laboratories. Free.
• URL: arupconsult.com
• License re-use: Free for clinical use; redistribution and AI ingestion require permission.
• Recommended posture: Use freely in clinician-facing UI; ask before ingesting.

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6. Research Datasets (Purchase or DUA)

For analytics, AI training, and population-health features. Most of these are not consumed at point of care; they're for the AI-substrate side of Starlight.

MIMIC-IV (PhysioNet / MIT-LCP)

• One-liner: Massive de-identified ICU + ED dataset from BIDMC. Free but requires CITI human-subjects training + signed DUA.
• URL: physionet.org/content/mimiciv
• Pricing: Free with credentialing.
• License re-use: PhysioNet Credentialed Health Data License 1.5.0 — research use only, no commercial product training without separate license, no patient re-identification, no redistribution.
• Pediatric subset: Limited — this is adult ICU. Pediatric MIMIC-style data is rare.
• Recommended posture: Use for research/algorithm prototyping; do not embed in commercial product without legal review.

eICU Collaborative Research Database (PhysioNet)

• Similar terms to MIMIC-IV; multi-center adult ICU.
• Recommended posture: Same as MIMIC.

PEDSnet

• One-liner: Pediatric learning health network — eight children's hospitals, common-data-model EHR data. Institutional/research only.
• URL: pedsnet.org
• Pricing: Membership / research-collaboration model; not a commercial license.
• Access: Researcher-affiliated requests, IRB-gated.
• Recommended posture: Skip as commercial product input. Pursue as a research partnership once Starlight has academic credibility.

TriNetX

• One-liner: Federated network of de-identified EHR data from 250+ healthcare orgs; commercial access for biopharma + research.
• URL: trinetx.com
• Pricing: Contact sales. Industry-known ballpark $100K–$1M+/yr depending on access tier and use case.
• License re-use: Strictly defined per contract; typically research-only with audit rights.
• Pediatric: Has peds sub-cohorts.
• Recommended posture: Skip pre-PMF. Evaluate post-PMF if we need population-scale evidence for AI features.

Optum Clinformatics Data Mart

• One-liner: Commercial claims + clinical data, ~80M lives, longitudinal.
• URL: optum.com
• Pricing: Contact sales. Industry-known ballpark $200K–$2M/yr.
• License re-use: Research-defined per contract.
• Recommended posture: Skip. Overkill for Starlight; revisit if/when we sell anonymized analytics.

Merative MarketScan (formerly IBM)

• One-liner: Commercial claims database — hospital encounters, retail prescriptions, lab results across ~50M lives/year.
• URL: merative.com/real-world-evidence
• Pricing: Contact sales. Industry-known ballpark $150K–$1.5M/yr by sub-database (Commercial, Medicare Supplemental, Medicaid, Lab).
• License re-use: Research-defined per contract.
• Pediatric: Available as Commercial peds subset.
• Recommended posture: Skip pre-PMF.

HealthVerity

• One-liner: Marketplace for de-identified health data sources — claims, EHR, social determinants. More flexible / smaller-buy-friendly than the Optum/Merative behemoths.
• URL: healthverity.com
• Pricing: Contact sales, but smaller starter buys (~$25K–$100K) reportedly available.
• Recommended posture: Skip pre-PMF, but the most plausible "first commercial dataset buy" of the bunch.

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7. Specialty Content Publishers

Bundle-buyer view rather than per-product:

Publisher Family	Includes	Bundle Notes
Wolters Kluwer Health	UpToDate, Lexicomp/Lexidrug, Medi-Span, Ovid, Facts & Comparisons	Best bundle if we go all-WK. Single AI-rights conversation.
Elsevier	ClinicalKey, Nelson's, Harriet Lane app, STATdx, ScienceDirect	Most restrictive AI terms. Avoid as primary.
EBSCO Health	DynaMed, Dynamic Health, DynaMed Decisions, journal aggregations	Best price-per-feature; second choice after WK.
AAP Publishing	Red Book, Bright Futures, PCO, Pediatrics, PIR	Required peds bundle at PMF.
NEJM Group	NEJM, NEJM Evidence, NEJM Journal Watch, Catalyst	Academic-priced individual ~$199/yr.
JAMA Network	JAMA + 11 specialty journals	Individual ~$200/yr; institutional ~$2K–$20K.
BMJ Group	BMJ Best Practice, BMJ journals, Archives of Disease in Childhood	Cheapest international Tier-1.

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Recommended Day-One License Stack (Pediatric DPC MVP)

Source	Why	Approximate Year-1 Cost
CPT distribution license (AMA)	Required for US billing	$5K–$25K
Lexicomp Pediatric & Neonatal feed	Pediatric e-prescribing safety	$50K–$150K (if e-Rx live)
AAP Bright Futures Tool & Resource Kit	Well-child operating system	$200–$5K
SNOMED CT (US, free via UMLS)	Clinical terminology	$0
RxNorm + DailyMed + NLM (free)	Med terminology + label data	$0
ICD-10-CM (free, CMS)	Diagnosis coding	$0

Add at PMF: UpToDate or DynaMed (clinician benefit), VisualDx (peds derm), AAP Pediatric Care Online, Red Book Online.

Avoid: ClinicalKey (Elsevier AI terms), STATdx, Primal Pictures, MarketScan/Optum/TriNetX (all overkill until we have a population-analytics product).

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License Re-use Cheat Sheet (Critical for Starlight AI)

Re-use	Permitted by typical license?
Display verbatim to licensed clinician at point of care	Yes
Display verbatim to patient	Usually no (separate patient-facing license)
Cache for performance	Sometimes (very limited)
Send into LLM context window for grounding	Almost universally NO without AI addendum
Train/fine-tune a model	No — separate AI training license required
Expose via our public API	No
Cite/attribute and link out	Yes

Implication for Starlight: the AI-substrate must default to free / open-licensed sources (PubMed, MedlinePlus, FDA, CDC, AAP open guidelines, Bright Futures free portion, OpenEvidence-the-API-when-it-exists) for any RAG or LLM-grounding workflow. Paid sources are for clinician-direct UI use, not AI training.

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Last updated: 2026-05. Pricing is approximate and subject to change; always confirm directly with vendors.