Healthcare electronic data interchange (EDI) enables the interchange of healthcare information which is managed using software in a consistent format. It upsurges accurateness, expands efficiency, assists in quicker identification of errors, and easiness of work for the pharmacies, healthcare providers, and payers. The global healthcare EDI market is growing at a significant rate, due to development of guidelines for transaction procedures, and mounting necessity to limit healthcare costs. The market has witnessed high demand for services over the last few years due to subcontracting of EDI services and need massive training programs.
Insight by Component
There are two component, services and solutions. Services segment account the larger share and is also expected to grow at the faster rate in the market due to budding need for scalability of EDI solutions, need massive training programs, mounting complexities in EDI solutions, and mounting outsourcing activities of EDI services by healthcare organizations.
Insight by Mode of Delivery
There are various modes of delivery, web and cloud-based EDI, mobile EDI, EDI van, and point-to-point EDI. Advantages such as scalability, inexpensive solution for small and medium-sized healthcare providers, compatibility with mobile device, no need of software fitting, and enhanced flexibility are some of the factors responsible for the growth of the web and cloud-based EDI segment. Of all the mode of delivery, the web and cloud-based EDI account the largest share in the healthcare EDI market.
Insight by Transaction Type
There are two transaction type, claims management and healthcare supply chain. Escalating occurrence of chronic diseases and lifestyle associated diseases is the factors growing the demand of claim management segment. Among the all transaction type, the claim management segment account the larger share in the healthcare EDI market. The claim management is further sub divided into referral certification and authorization, claims submission, payment remittance, claim payment, claim status, eligibility verification, and others.
Insight by End User
There are various end users including pharmacies, healthcare providers, medical device and pharmaceutical industries and healthcare payers. Mounting demand for insurance plans and disease risk assessment are the factors growing the demand of healthcare EDI market for healthcare payer. Among the all end users, the healthcare payer exhibit the largest share in the healthcare EDI market. Moreover, healthcare providers are expected to grow at the fastest rate in the market due to mounting acceptance of EDI for performance management, financial management and operational intelligence by hospitals, physicians, clinics and clinicians.
Boosting usage of EDI in healthcare manufacturing industry, and mounting emphasis on integration platform as a service (IPAAS) are the major trends in the healthcare EDI market.
The development of guidelines for transaction procedures, escalating occurrence of chronic diseases and lifestyle associated diseases mounting necessity to limit healthcare costs, and government assistance for HCIT are the primary growth drivers for healthcare EDI industry. For instance, according to Centers for Disease Control and Prevention in 2012, approximately 117 million people in the U.S. had one or the more chronic conditions. Upsurge in outsourcing of EDI facilities and initiation of ICD-11 strategies are also facilitating the growth for the healthcare EDI market.
The high implementation cost of the software, and lack of data security are the major challenges for the growth of healthcare EDI market. Reluctance to shift from conventional techniques and end user restrictions and requirements are also some of the factor hindering the global market growth.
Globally, the manufacturing companies trying to enter the healthcare EDI market are required to maintain stringent regulatory standards. Moreover, the high level of capital requirement also poses a major barrier for the entry of new players. This offers an edge to the established players in the industry competition.
Geographically, North America is the largest healthcare EDI market as in the region the number of HCIT companies is increasing. Promising guidelines, escalating occurrence of chronic diseases and lifestyle associated diseases, mounting request for inventive IT solutions to simplify workflows and mounting acceptance of healthcare EDI in privileges and supply chain management are also up surging growth of the North American healthcare EDI market.
Asia-Pacific is observed to witness the fastest growth in the market, as the region comprises of large population base. In addition, execution of HCIT programs, escalating occurrence of chronic diseases and lifestyle associated diseases, budding necessity to supervise large amount of patient data, government efforts to improve healthcare coverage and reimbursement processes and demand to curtail healthcare costs are also creating a positive impact on the healthcare EDI market growth in the region.
Key players in the healthcare EDI market are catering the demand of these devices by investing on technologically advanced products in their product portfolio across the globe. In January 2018, Mckesson Corporation completed acquisition of RxCrossroads, to provide commercial support, and logistics services to pharmaceutical and biotechnology manufacturers. Mckesson Corporation, Cognizant Technology Solutions Corporation, Optum, Inc., Dell Technologies Inc., Quality Systems Inc., Experian PLC, Synnex Corporation, Cerner Corporation, and Allscripts Healthcare Solutions, Inc., are the key players offering healthcare EDI solutions.