Asia Pacific Healthcare Electronic Data Interchange (EDI) Market to Grow at a CAGR of 14.5% to reach US$ 1,208.20 million from 2022 to 2030

The healthcare EDI market size is expected to grow from US$ 409.35 million in 2022 to US$ 1,208.20 million by 2030; it is estimated to register a CAGR of 14.5% from 2022 to 2030.

Analyst’s ViewPoint

The healthcare EDI market analysis explains market drivers such as the growing need for seamless processing of healthcare claims and administrative transactions, and increasing adoption of healthcare EDI platform in supply chain tracking. Further, technological advancements in healthcare EDI are expected to introduce new trends in the market during 2022–2030. Based on component, the solution segment accounted for a larger share in 2022. Based on delivery mode, the web-based & cloud-based segment dominated the market by accounting maximum share. By application, the claims management segment dominated the market by accounting the maximum share. By end user segment, the healthcare providers segment is likely to account for a considerable share of the healthcare EDI market during 2022–2030.

Electronic data interchange (EDI) in healthcare is a secure way of transmitting data between healthcare institutions, insurers, and patients using established message formats and standards.

Market Insights

Growing Need for Seamless Processing of Healthcare Claims and Administrative Transactions

EDI is a secure way to transfer healthcare data. EDI is regularly utilized by clinics, hospitals, medical practices, and other healthcare companies to transfer medical information. ASC X12, version 5010, is one such example. ASC X12 develops and maintains standards for EDI related to healthcare administrative transactions. Below are a few commonly used ASC X12 transactions frequently adopted in the dental industry.

Commonly Used ASC X12 Transactions in Dental Industry

Transaction Type	Description
ASC X12 270	This transaction allows providers to check whether the patient has an insurance coverage. National Dental Electronic Data Interchange Council (NDEDIC) is working to promote high utilization of ASC X12 270/271 within the dental industry.
ASC X12 271	This transaction is an electronic response for eligibility inquiry. The responses by the consumers reveal whether the patient has insurance coverage and accordingly offer benefits available to patients.
ASC X12 275	The ASC X12 275 is an electronic transaction used for responding to the insurance company's information by sending "ASC X12 277 RFI to the provider. The ASC X12 275 comprises additional data and/or digital images (x-rays, periodontal charts, treatment notes, etc.) to support the healthcare claims. The transaction is not widely used.
Other ASC X12	Other transactions comprise ASC X12 276, ASC X12 277, ASC X12 277CA, ASC X12 277U, ASC X12 RFI, ASC X12 837, ASC X12 835, ASC X12 997, ASC X12 999

Source: The Insight Partners Analysis

Additionally, healthcare EDI significantly decreases the time taken to submit and process the claim. For example, not only do EDIs help identify potential mistakes within the claims to be submitted but also assist in processing and providing real-time feedback about the claims submission. For example, the utility of EDI automates manual processes, eliminating paper, printing, physical storage, and cost savings. Also, electronic documents can be processed more quickly as compared to manual processes, ensuring customer needs are met with customer satisfaction. Further, the adoption of EDI in healthcare helps reduce healthcare costs and smooth processes. The adoption of GS1 EDI by Ramsay Healthcare is one such example. Ramsay Healthcare has deployed a full suite of GS1 standards for identifying, capturing, and sharing information that supports interaction with the suppliers. Therefore, the adoption of the GS1 standard suite, Ramsay Healthcare, has increased both the speed and efficiency in purchasing processes that efficiently support operations in hospitals and help ensure continuous delivery of quality healthcare. Procure-to-pay processing costs have been decreased by ~95% per document in Ramsay Healthcare due to the adoption of the GS1 standard suite. Therefore, healthcare efficiency allows healthcare claims to be processed faster through EDI, ultimately driving the market growth.

Future Trend

Technological Advancements in Healthcare EDI

Healthcare organizations deal with vast amount of data every day, starting from patient records and claims to lab results and prescriptions. ~50% of the hospitals in the US have unstructured data, causing a major hindrance in improving the overall healthcare interoperability and connected care initiatives, as per the published report in 2023 by Astera Software. Therefore, technological advancements stand as a reliable solution that can help hospitals overcome challenges associated with hospital-generated data. The Pilotfish’s "ei Console for X12" launched in 2020 is one such example of technological advancement in healthcare EDI. Pilotfish is the only solution that validates healthcare X12 EDI data, translates it, and maps it from any other application by delivering features and modules by reducing minimal complexity. Also, the "eiConsole" for X12 EDI includes an EDI Format Builder that loads a rich data dictionary for EDI transactions, such as field-level documentation and friendly source names. Also, in the eiConsole, the EDI format reader provides automatic prices and reads in X12 transactions.

In September 2022, Prodigo Solutions announced the release of its next-generation EDI platform "Xchange" for healthcare clients that leverage supply chain modernization initiatives and automate transaction processes. This next-generation Xchange has a significantly faster processing time with a small memory footprint to support the ever-increasing volume of EDI documents being transmitted between trading partners. Therefore, with technological advancements in healthcare EDI features, the overall operational efficiency of the healthcare industry is likely to improve, which will promote the market growth during 2022–2030.

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Asia Pacific Healthcare Electronic Data Interchange (EDI) Market: Strategic Insights

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Report Segmentation and Scope

Component-Based Insights

Based on component, the healthcare EDI market is bifurcated into solution and services. The solution segment held a larger share of the market in 2022 and is anticipated to register a higher CAGR of 14.9% in the market during 2022–2030. Electronic data interchange (EDI) solution comprises data conversion in readable formats, interoperability, IT tools, and data security. For example, the current version of the EDI solution includes standardized messaging to enable seamless information exchange within healthcare organizations. Also, top companies such as IBM provide "IBM WebSphere Data Interchange" solutions that support service-oriented architecture (SOA) and business process management (BPM) implementation. Also, the "IBM WebSphere Data Interchange" solution facilitates the creation, deployment, execution, and management of data transformation and related standards-based processing between standard-based EDI formats and internal application data formats. The IBM WebSphere Data Interchange is utilized in multiple industries, including healthcare. The aforementioned factors are responsible for influential growth of the segment growth.

Delivery Mode-Based Insights

Based on delivery mode, the healthcare EDI market is segmented as web-based & cloud based, EDI value added network (VAN), direct/point-to-point EDI, mobile EDI, and others. The web-based & cloud based segment held the largest market share in 2022 and is anticipated to register the highest CAGR of 15.2% during 2022–2030. Web-based EDI conducts EDI through an internet browser and replicates paper-based documents in the web format. The form comprises fields where the user needs to fill in the information. Once the relevant information is added, it is automatically converted into an EDI message and sent through a secure internet protocol such as File Transfer Protocol Secure (FTPS) and Hyper Text Transport Protocol Secure (HTTPS) or AS2. Web EDI is the simplest form of technology that small and medium-sized enterprises can adopt to create, receive, turn around, and manage electronic documents using a browser.

Likewise, cloud-based EDI solution offers lucrative benefits such as flexibility and scalability, cost-effectiveness, and cloud computing advantage. For example, big healthcare companies such as GE Healthcare is shifting focus from traditional data exchange platform to cloud-based EDI because of improving agility and IT flexibility within the company operations. Also, cloud EDI software provides a combination of technological and business process improvement designed to meet the demands of the organization. From data transformational capabilities to streamlining automation, cloud EDI puts the enterprise in a position to tackle any integration challenges without having to deploy and manage software and hardware.

Application-Based Insights

In terms of application, the healthcare EDI market is categorized into claims management and healthcare supply chain. The claims management segment held a larger market share in 2022 and is anticipated to register the highest CAGR of 14.6% during 2022–2030.

EDI is a standard and routinely used across the healthcare industry, allowing both payers and healthcare professionals to send and receive claims-related information faster, avoiding delays and reducing administrative expenses. The EDI benefits healthcare claims management as follows:

• Electronic claims are automatically checked for HIPAA and payer-specific requirements at the vendor, clearinghouse, and payer levels. Such electronic claims decrease the number of claim rejections, and the same level of automated data generated through EDI cannot be performed on paper claims.
• EDI reduces call timings, obtain information about members, and process claims-related payments through verified authorizations.

For instance, XactAnalysis constantly monitors the data to identify errors, track progress, benchmark performance to reduce claims cost and errors, as well as increases the precision speed of healthcare claims settlements. Additionally, XactAnalysis provides real-time quality assurance and review tools, bulk assignment import, estimates audits, display performance scorecards, assignment network, and many more.

End-User Based Insights

The Asia Pacific healthcare electronic data interchange (EDI) market, by end user, is segmented as healthcare providers, healthcare payers, medical & pharmaceutical industries, and pharmacies. The healthcare providers segment held the largest market share in 2022 and is anticipated to register the highest CAGR of 14.7% during 2022–2030. Healthcare providers require a broad set of tools that drive clinical, financial, and operational success. "Oracle Health" is one such example that strives to streamline clinical and operational workflows to enhance productivity and outcomes across ambulatory clinics and ambulatory surgery centers (ASCs). This is well understood by the following case study, where Children's Minnesota partnered with Oracle Health to maximize efficiency and support quality care. Additionally, Children's Minnesota was able to streamline ready care services or urgent care by utilizing Cerner's new ED LaunchPoint product. The product provided direct visibility to current patient visits and actions as well as a patient summary view with a single click. Further, to support mobility across all patient visit types, "PowerChart Touch" was rolled by Cerner at Children's Minnesota’s primary care. For example, "PowerChart Touch" supports provider mobility on smartphones or tablets, allowing providers to review charts, take photos for easy data/report transfer, and document with in-built dictation software. Such innovative product launches by the providers for efficient and smooth functioning of the healthcare organization promote the overall market growth.

Healthcare EDI Market, by Component – 2022 and 2030

 

 

Regional Analysis

The Asia Pacific healthcare EDI market is segmented into China, India, Japan, South Korea, Australia, and Rest of Asia Pacific. China accounted the largest share of healthcare EDI market. According to the National Institute of Health (NIH) report, China has realized the benefits of adopting electronic data interchange (EDI). For example, data governance systems in the field of healthcare seek to balance and share health data. Also, regulatory need is important as there is a massive amount of health data generated. Therefore, China's Ministry of Health (MOH) has planned to undertake a major project, "the China Golden Health Medical Network Project," in October 2023 to establish a satellite-transmitted nationwide healthcare communication network. The project is set to launch the Golden Health Card, a smart card with an embedded chip to save patient financials and medical information and help patients obtain appropriate healthcare services from hospitals at different geographic locations. Under the same project, the hospitals have started using EDI to communicate with other hospitals, medical resource suppliers, insurance companies, and banks.

The EDI services were first conducted in Beijing hospitals to promote EDI usage in China's healthcare organizations. Beijing was chosen as a research site for the implementation of EDI because it is the capital of China and one of the most industrialized cities. Also, many organizations in Beijing have well-developed IT infrastructure. Therefore, hospitals in Beijing receive more assistance from the government and various industry organizations implement EDI in hospitals. The influx of EDI in Chinese hospitals makes remarkable changes in Level 3 and lower-level hospitals. For example, outpatient registration fees are determined by the healthcare policy in China, and the registration fee difference between Level 3 and lower level hospitals is approx. US$ 0.2. With the difference being so slight, many patients are willing to pay more to go to Level 3 Chinese hospitals with better services. Therefore, Level 1 and Level 2 Chinese hospitals have a fewer outpatient visits, and Level 3 hospitals have long waiting lines. With long waiting lines in Level 3 hospitals, it is more likely to adopt IT infrastructure to maintain competitiveness. However, for low-level hospitals, patient attraction is a critical issue, and they are more likely to invest in marketing rather than IT. Therefore, the implementation of EDI offers both advantages, including IT and marketing, for both Level 3 and low-level hospitals. Thus, such remarkable features provided by the EDI help healthcare system in China dominate the market.