Healthcare EDI Market

Industry Overview

The global healthcare electronic data interchange market is expected to grow from USD 4.41 billion in 2023 to USD 9.18 billon by 2030 at a CAGR of 9.6% within the forecast period ranging from 2025 to 2030. Healthcare Electronic Data Interchange (EDI) refers to a process that enables the interchange of healthcare information. It is usually managed by a specific software program that helps to maintain a consistent format. The process helps in maintaining accuracy, increases efficiency, helps to identify errors quickly, and simplifies the work for the pharmacies, healthcare providers, and payers by automating processes from claims submission and payment, insurance eligibility checks, and data reporting.

The global healthcare EDI market is growing at a fast rate due to developed guidelines for transaction processes and growing demand for restricting healthcare costs. It is also attributed to subcontracting of EDI services and rise in the number of end users and growing adoption of EDI. Healthcare regulatory initiatives and compliance requirements such as HIPAA in the United States and GDPR in Europe to ensure protection and security of patient information and data have driven the adoption of EDI solutions promoting the growth of the EDI market.

The high cost of implementation of the software related to EDI and the lack of proper data security measures are the major challenges for the growth of healthcare EDI market. Several opportunities for the growth of the global healthcare EDI marker are emerging due to technological developments and growing adoption of digital solutions in the healthcare sector.

Market Segmentation

Insight by Component

The global healthcare EDI market is divided on the basis of components into services and solutions. Out of these two segments, the services segment will account for the larger market share and will also grow at a significantly higher CAGR during the forecast period due to higher need for scalability of EDI solutions, complexities in EDI solutions, and rising outsourcing activities of EDI services by healthcare organizations.

Insight by Mode of Delivery

The global healthcare EDI market is also divided by different modes of delivery into web and cloud-based EDI, mobile EDI, EDI van, and point-to-point EDI. Out of these segments, the advantages offered 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 that will help the web and cloud-based EDI segment to grow more during the forecast period.

Insight by Transaction Type

The global healthcare EDI market is divided mainly be two types of transactions namely, claims management and healthcare supply chain. Out of these two segments, the claims management segment will grow more during the forecast period due to growing occurrence of chronic diseases and lifestyle associated diseases.

Insight by End User

The global healthcare EDI market is also divided by different end users into pharmacies, healthcare providers, medical device and pharmaceutical industries and healthcare payers. Out of these segments, the healthcare payers segment will grow at a higher rate during the forecast period due to the growing demand for insurance plans and disease risk assessment. However, the healthcare providers segment will also grow significantly due to higher acceptance of EDI for performance management, financial management and operational intelligence by hospitals, physicians, clinics and clinicians.

Global Healthcare EDI Market Report Coverage

Industry Dynamics

Industry Trends

The higher acceptance and adoption of EDI in healthcare manufacturing industry is a growing trend in the global healthcare EDI market. In addition, the growing emphasis on integration platform as a service (IPAAS) and higher demand for technologically advanced electronic data interchange services and solutions such as web-based EDI are also significant trends noticed in the industry that help to address issues regarding confidentiality, authentication, and data integrity. In addition, there are different methods used to deliver electronic data interchange services and solutions such as cloud-based EDI, EDI Value Added Network (VAN), Direct (point-to-point) EDI, Mobile EDI, Applicability Statement version 2 (AS2), File Transfer Protocol over Virtual Private Network (FTP/VPN), Secure File Transfer Protocol (SFTP) or File Transfer Protocol Secure (FTPS).

Growth Drivers

The rising occurrence of chronic diseases and lifestyle associated diseases is fueling the demand to manage healthcare expenditure. This is promoting the growth of the global healthcare EDI market. The growth of the market is also attributed to the government assistance for HCIT, initiation of ICD-11 strategies, growing adoption and higher applicability in pharmaceutical & medical device industries and a large number of hospitals across the world to curtail costs. In addition, the increasing tie-ups with several different vendors or suppliers along with the growing competitiveness, pricing pressure, and lower profit margins fuels the demand for it in the hospitals and thereby promoting market growth.

Challenges

The growth of the global EDI market is hindered by the reluctance to shift from conventional techniques and end user restrictions and strict requirements. In addition, the new manufacturing companies trying to enter the healthcare EDI market are required to maintain stringent regulatory standards, preventing their entry. The high capital requirement also poses a major barrier for the entry of new players, thereby restricting market growth.

Opportunities

The growth opportunities to the market are mainly reliant on the growing adoption of advanced solutions such as cloud-based solutions to streamline operations and reduce costs, rising demand for interoperability to promote efficient data exchange in standardizing data formats and protocols, integration of artificial intelligence (AI) and machine learning (ML) technologies into EDI systems to enhance automation, data analytics, and predictive capabilities, and growth of telehealth services.

Geographic Overview

North America holds the largest share of the healthcare EDI market due to the increasing number of HCIT companies in the region, promising guidelines, rising occurrence of chronic diseases and lifestyle associated diseases, growing demand for inventive IT solutions to simplify workflows and higher acceptance of healthcare EDI in supply chain management.

Asia-Pacific will observe a high growth rate during the forecast period due to the large population base. In addition, the growth of the market in this region is also attributed to the greater execution of HCIT programs, rising occurrence of chronic diseases and lifestyle associated diseases, growing need for supervising and managing a large amount of patient data, supportive government efforts to improve healthcare coverage and reimbursement processes, and the rise in demand to curtail healthcare costs.

Competitive Insight

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. 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.

Cognizant Technology Solutions Corporation is an American multinational information technology services and consulting company. It is headquartered in Teaneck, New Jersey, U.S. Cognizant helps companies modernize technology, reimagine processes and transform experiences so they stay ahead in a fast-changing world. 

Dell is a leading provider of infrastructure, cloud and end user technology solutions that promote healthcare IT and digital transformation.

Recent Developments by Key Players

Optum-owned Refresh Mental Health has acquired fast-growing outpatient mental health provider CARE Counseling, according to several sources close to the matter.

The Healthcare EDI Market report offers a comprehensive market segmentation analysis along with an estimation for the forecast period 2025–2030.

Segments Covered in the Report

• By Component
  • Services
  • Solutions
• By Mode of Delivery
  • Web and Cloud-based EDI
  • Mobile EDI, EDI Van
  • Point-to-Point EDI
• By Transaction Time
  • Claims Management
  • Healthcare Supply Chain
• By End User
  • Pharmacies
  • Healthcare Providers
  • Medical Device
  • Pharmaceutical Industries
  • Healthcare Payers

Region Covered in the Report

• North America
  • U.S.
  • Canada
  • Mexico
• Europe
  • Germany
  • U.K.
  • France
  • Italy
  • Spain
  • Russia
  • Rest of Europe
• Asia-Pacific (APAC)
  • China
  • Japan
  • India
  • South Korea
  • Rest of Asia-Pacific
• Rest of the World (RoW)
  • Brazil
  • Saudi Arabia
  • South Africa
  • U.A.E.
  • Other Countries

Source: VynZ Research

Source: VynZ Research