EDI to Shape the Future of Healthcare

  • April 13, 2021

Have you sought medical care for any purpose?

Yes, then you know the amount of paperwork that you need to do. Long forms with even longer paragraphs in fine-print make it hard to read, understand and sign.

Now imagine the other side, for every patient, a hospital generates huge amounts of paperwork. Medical forms containing sensitive information move from department to department and at times to external companies, like insurance providers, giving chance for errors and medical malpractices.


You can only imagine the chaos and confusion present, with multiple patients, insurance providers, hospital staff, labs, etc., and the large amounts of forms, data and manual processes.

On these lines, to protect and secure healthcare information, the Workgroup for Electronic Data Interchange (WEDI) was formed in 1991 and was also listed in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulation. The introduction on WEDI was a huge success in streamlining 400+ paper-based medical forms and eliminating multiple formats.

Apart from standardised medical forms, there are multiple manual processes that have to be carried out. The manual steps can be tackled by introducing technologies which will run your business more efficiently. By introducing EDI or newer technologies that have traceable capabilities, you can protect classified or sensitive information from being lost, misdirected or intercepted.

Why did EDI originate?

Electronic Data Interchange was developed by the transportation industry in the 1960s to initiate accurate digital communication between customers and vendors. Following the transportation industry, many other industries subsequently adopted EDI.

Today, it has been made mandatory for all major industries to employ EDI and follow EDI compliance. To imagine the business world without EDI, you’ll have to imagine doing business without a telephone. You’ll see wide scale adoption in the retail sector, however, healthcare companies are slowly but steadily turning towards EDI.

EDI is the standardised format of electronic documents shared among companies, streamlining the supply chain. It is not only secure, fast, and cost-effective but is also one of the first steps to automating business processes.

EDI’s Role in the Healthcare Sector

Thanks to EDI, the mammoth collaboration and communication networks in the healthcare sector is digitally transformed. This has resulted in healthcare businesses delivering timely, satisfactory customer experiences, including:

Increased speed of data exchange between patients and healthcare participants
Reliable and secure data transmission
Affordable healthcare

EDI coupled with other leading technologies ensures that patient information is transferred between healthcare stakeholders and payers in a standardized, secure, and efficient manner. It also enables you to immediately:

Check patient’s eligibility and benefits, referrals, authorizations and notifications
Receive deposit of claim payments and much more
Submit and check claims

By adopting EDI and other emerging technologies, healthcare organizations will be better positioned to tackle challenges, cost and enhance process efficiency. There are multiple benefits of EDI but a major one is the reduction of administrative effort.

Why use EDI?

If you’re wondering how it will improve cash flow and save time, it is because EDI helps you confirm a patient’s eligibility immediately and bill the right payer. Also, electronic communication including Electronic Funds Transfer (ERA) and Electronic Remittance Advice (EFT) reduces manual handling and follow up time-directing payments deposits straight into your accounts.

To improve your cash flow

To make better use of your time

If you’re wondering how it will improve cash flow and save time, it is because EDI helps you confirm a patient’s eligibility immediately and bill the right payer. Also, electronic communication including Electronic Funds Transfer (ERA) and Electronic Remittance Advice (EFT) reduces manual handling and follow up time – directing payments deposits straight into your accounts.

Healthcare EDI: Data Interchange and Security

To begin with, the healthcare EDI and HIPAA system ensures that patient records are viewed by only those authorised to access it, lowering risk of hefty financial penalties. Additionally, standardisation of electronic healthcare transactions removes the need to tackle or decode any foreign messages.

As the messages being sent and received are clear and automated, data automatically goes into the needed systems, helping healthcare businesses save time and money. When all data transactions are handled by the computer, accuracy automatically improves.

Furthermore, removal of manual processes will reduce human errors, chargebacks or expensive mistakes. Your staff can reduce making phone calls. They can check referrals, notifications and precertification requests effortlessly and manage multiple claims at the same time. And, one can confidently trust the information at hand.

We’re reemphasizing cost savings, as they can be huge. You not only save by replacing paper forms but with faster, accurate systems in place and a robust communication line set up, process efficiency is bound to increase.

Things to Consider Before You Choose EDI

Stop Working in Silos – Healthcare systems have numerous definitions, data formats, and processes which have been used for years. It is time to move on. Adopt a unified, standard format and make information sharing easy. Provide everyone who is authorized easy access to quality data and reduce the administrative burden.

According to MarketsandMarkets, the healthcare EDI market is forecast to be worth 3.77 Billion USD by 2022. This growth means a growth in data volume. It will demand technology to support it. And, now would be the best time to adopt EDI and not be left behind in the race where it really matters.

If you have any comments or questions, feel free to write to us here. We urge you to get on a quick call or demo with us to know how to get started and adopt EDI into your healthcare business.
Embrace digitalisation and establish sustainable processes!