Market Overview
Healthcare electronic data interchange (EDI) facilitates the exchange of healthcare data which is processed using computer software in a standardized format. Healthcare industry processes a large number of documents such as medical records of patients, healthcare claims, and reimbursement records. Healthcare EDI helps in the exchange of this information among healthcare institutions, healthcare professionals, and patients. The use of healthcare EDI increases accuracy, improves productivity, helps in faster identification of errors, consumes less time, secures exchange of information and leads to ease of work for the healthcare providers, healthcare payers, and pharmacies. Healthcare EDI finds application in insurance and reimbursement data management, clinical trials and regulatory data management, and medical and dental patient database management. They key players such as Dell Technologies Inc. are prompting the growth of the global healthcare EDI market. In February 2017, Dell Technologies Inc. quickened the digital transformation in healthcare EDI market with the introduction of cloud integration solution for healthcare EDI.
On the basis of component, the global healthcare EDI market is segmented into services and solutions. Services held larger share of the global healthcare EDI market in 2016, mainly due to rise in outsourcing activities and complexities in EDI solutions. Complexities in the EDI solutions prompt the end users to adopt these services for proper understanding and ease of use of healthcare EDI. Based on delivery mode, the web & cloud-based EDI was the largest contributor in the global healthcare EDI market in 2016. The factors such as high scalability, low cost, mobile devices compatibility, and no requirements of software installation are driving the growth of the segment. Based on type of transaction, claims management registered the largest share in 2016, mainly due to increasing prevalence of chronic and lifestyle associated diseases.
Healthcare EDI market is regulated by various regulatory guidelines, that make the transactions between the healthcare payers, healthcare providers, medical device and pharmaceutical industries and pharmacies easier. Regulators have established many guidelines for different transaction in the healthcare EDI market such as EDI health care claim payment, EDI retail pharmacy claim transaction, EDI benefit enrollment and maintenance set and EDI payroll deducted and other group premium payment for insurance products.
Market Dynamics
Growth Drivers
Global healthcare EDI market is expected to grow significantly during the forecast period. Some of the major factors driving growth of the market include expanding base of patient due to the increasing prevalence of chronic diseases, rising need to curtail healthcare costs, and government support for healthcare EDI. According to the World Health Organization (WHO), chronic disease is the leading cause of mortality globally, comprising 60% of all deaths. Also, approximately 17.7 million people died from cardiovascular diseases in 2015, representing 31% of all global deaths. Of these deaths, an approximate of 7.4 million deaths were due to coronary heart disease and 6.7 million were due to stroke. WHO also reported that globally 8.8 million people died from cancer which is 1 in 6 of all global deaths in 2015. With the rise in these chronic diseases, the volume of patient is also increasing. Moreover, these large number of deaths also prompts the end users to avail healthcare EDI products for different reimbursements claims.
Restraints
The limited technological access in regions such as Asia-Pacific, and high implementation cost of EDI software act as major barriers for the growth of the global healthcare EDI market. Additionally, data security is a major concern for the users of EDI which is likely to hamper the growth of the global healthcare EDI market. With the prevalence of on-line hacking and data theft, the security of the data and information of patient has become a major concern for the healthcare EDI users.
Opportunities and Trends
The key trend witnessed in the global healthcare EDI market is increasing number of research and development activities. With the rising prevalence of adoption of advanced technology in the healthcare market, the key players are investing more on the research and development on healthcare EDI, for the growth of the global healthcare EDI market. Additionally, increasing use of EDI in healthcare manufacturing and distribution industry and growing focus on integration platform as a service (IPAAS) are major trends observed in the global healthcare EDI market. The increase in outsourcing of EDI services and introduction of ICD-11 guidelines are creating ample opportunities for the growth of the global healthcare EDI market.
Insights by Geography
Geographically, North America was the largest market for healthcare EDI in 2016, followed by Europe and Asia-Pacific. Some of the major factors driving the growth of the global healthcare EDI market in North America include, presence of a large number of healthcare EDI companies and rising demand for the innovative technological advancements in the healthcare market. Adoption of EDI services for supply chain management in hospitals and increased government efforts for improvement in reimbursement processes and healthcare coverage are driving the growth of the European healthcare EDI market. Asia-Pacific is expected to witness fastest growth during the period 2017 – 2023, due to the increasing healthcare expenditure by government, rising focus on research and development and technological investment.
Competitive Landscape
Some of the key players in the global healthcare EDI market are GE Healthcare, Cognizant Technology Corporation, Cerner Corporation, Axway Software SA, Dell Technologies Inc., Synnex Corporation, McKesson Corporation, Allscripts Healthcare Solutions Inc., SSI Group, LLC, Comarch SA, Optum Inc., and Quality Systems Inc.
With respect to strategic developments, various new product launches and strategic alliances have been taking place in the healthcare EID market.
In April 2017, McKesson Corporation completed the acquisition of CoverMyMeds. CoverMyMeds’ software suite can automate the medication the medication prior to the authorizing process for more than 49,000 pharmacies, 500 electronic health records system, and 700,000 providers.
MARKET SEGMENTATION
By Component
By Delivery Mode
- Web & Cloud-based EDI
- EDI VAN
- Point-to-Point EDI
- Mobile EDI
By Transaction Type
- Claims Management
- Claims Submission
- Claim Status
- Eligibility Verification
- Payment Remittance
- Referral Certification & Authorization
- Claim Payments
- Others
- Healthcare Supply Chain
By End User
- Healthcare Providers
- Healthcare Payers
- Medical Device & Pharmaceutical Industries
- Pharmacies
Geographical Segmentation
- North America
- Europe
- Germany
- U.K
- France
- Italy
- Spain
- Rest of Europe
- Asia-Pacific
- China
- India
- Japan
- Rest of Asia-Pacific
- Latin America
- Brazil
- Mexico
- Rest of Latin America
- Middle East & Africa (MEA)
