An institutional repository (IR) is an online digital archive that organizes, preserves, and provides access to the educational, scholarly, and research output of an institution. Medical libraries began establishing IRs more than a decade ago and these repositories have become an important component of scholarly communication outreach. In an article in the 2014 Against the Grain health and biomedical sciences special issue, Palmer described institutional repository services provided by health sciences libraries, and the barriers and challenges to providing those services. What has changed since 2014? What is the current landscape for repositories in medical and health sciences libraries?