EXHIBIT 10.11

                       FIFTH AMENDMENT TO CREDIT AGREEMENT

         This  Amendment,  dated as of  October 7, 1998  (this  "Amendment")  is
entered  into by and between MEDE AMERICA  CORPORATION,  a Delaware  corporation
(the "Company") and BANK OF AMERICA NATIONAL TRUST AND SAVINGS  ASSOCIATION (the
"Bank").

                                    RECITALS

         The Company and the Bank are parties to a Credit  Agreement dated as of
December 18, 1995,  as amended (the "Credit  Agreement"),  pursuant to which the
Bank  extended  a  revolving  credit  facility.  Capitalized  terms used and not
otherwise  defined  or  amended  in  this  Amendment  shall  have  the  meanings
respectively assigned to them in the Credit Agreement.

         The Company has  requested  that the Bank extend the maturity  date, to
increase the commitment and to change the relative  percentage  contributions of
the Guarantors.  In order to induce the Bank to agree to the foregoing, the Bank
has requested,  and the Company has agreed, to pay an amendment fee. The Company
has  requested  that the Bank enter into this  Amendment in order to approve and
reflect the foregoing,  and the Bank has agreed to do so, all upon the terms and
provisions and subject to the conditions hereinafter set forth.

                                    AGREEMENT

         In  consideration  of  the  foregoing  and  the  mutual  covenants  and
agreement hereinafter set forth, the parties hereto mutually agree as follows:

A.       AMENDMENTS.

         1.  Amendment  of  Section  1.01.  Section  1.01 is hereby  amended  by
amending the definitions of:

                  (a)  "Guarantor's  Support  Percentage"  shall  mean  (A) with
         respect to the first  $20,000,000 of Loans outstanding (i) with respect
         to WCAS V, 0%; (ii) with respect to WCAS VI, 80%; (iii) with respect to
         WB  Leveraged  Capital,  1.6%;  and (iv)  with  respect  to WB  Capital
         Partners,  18.4%; and (B) with respect to the remaining  $16,000,000 of
         Loans outstanding (i) with respect to WCAS V, 80%; (ii) with respect to
         WCAS VI, 0%; (iii) with respect to WB Leveraged  Capital,  0%; and (iv)
         with respect to WB Capital Partners, 20%.

                  (c)   "Revolving    Commitment"   by   deleting   the   amount
         "$20,000,000" and substituting the amount "$36,000,000" therefor; and



                  (d) "Revolving Termination Date" by deleting the date "October
         31, 1998" and substituting the date "October 29, 1999".

         2.       Addition  of  New  Covenant.   Article VI is hereby amended by
         adding the following as a new Section 6.14:

                  Section 6.14 Year 200 Compliance. The Company has completed or
         accomplished, or will complete or accomplish, the following:

                           (a) By August  31,  1999,  prepare  a  comprehensive,
                  detailed  inventory  and  assessment  of the risk posed by the
                  "Year  2000  problem"  as it  may  affect  the  Company's  own
                  business, properties or operations;

                           (b) By August 31,  1999,  make a detailed  inquiry of
                  material  suppliers,  vendors and customers of the Company, to
                  ascertain  whether  such  persons  are  aware  of the  need to
                  address  the Year 2000  problem  and  whether  they are taking
                  appropriate steps to do so;

                           (c) By August 31,  1999,  prepare a detailed  project
                  plan and budget  for  ensuring  that the Year 2000  problem is
                  successfully addressed in all material respects as it pertains
                  to thou Company's own business,  properties or operations, and
                  containing  contingency  plans to mitigate  the effects of any
                  third  party's  unexpected  failure to  address  the Year 2000
                  problem;

                           (d) By August 31,  1999,  renovate  all  systems  and
                  equipment  affected by the Year 2000  problem to cause them to
                  perform correctly  date-sensitive  functions for relevant date
                  data from  before and after  December  31,  1999  ("Year  2000
                  Compliance")  or replace them with technology not so affected,
                  and commence testing; and

                           (e)  By  August  31,  1999,   complete   testing  and
                  installation  of all material  systems and equipment to ensure
                  timely Year 2000 Compliance.

                  For the purpose of this  Section  6.14,  "'Year 2000  Problem'
         shall mean the inability of computers,  as well as embedded  microchips
         in non-computing devices, to perform properly date-sensitive  functions
         with respect to certain dates prior to and after December 31, 1999."

B.       REPRESENTATIONS AND WARRANTIES.

         The Company hereby represents and warrants to the Bank that:

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         1. No Event of Default  specified in the Credit  Agreement and no event
which with notice or lapse of time or both would become such an Event of Default
has occurred and is continuing;

         2. The  representations  and warranties of the Company  pursuant to the
Credit  Agreement  are true on and as of the date hereof as if made on and as of
said date;

         3. The making and  performance  by the Company of this  Amendment  have
been duly authorized by all corporate action; and

         4. No  consent,  approval,  authorization,  permit or license  from any
federal or state regulatory  authority is required in connection with the making
or performance of the Credit Agreement as amended hereby.

C.       CONDITIONS PRECEDENT.

         This  Amendment  will become  effective as of October 7, 1998  provided
that the Bank shall have  received  in form and  substance  satisfactory  to the
Bank, all of the following:

         1. A copy of a  resolution  passed  by the  Board of  Directors  of the
Company,  certified by the Secretary or an Assistant Secretary of the Company as
being in full force and effect on the date  hereof,  authorizing  the  borrowing
herein  provided for and the execution,  delivery and  performance of the Credit
Agreement as hereby amended.

         2. A certificate of incumbency  certifying the names of the officers of
the Company authorized to sign this Amendment, together with the true signatures
of such officers.

         3. Executed counterparts of this Amendment.

         4. Payment of an amendment fee in the amount of $25,000.

         5. A copy of the executed  asset purchase  agreement  among the Company
and the stockholders of HealthCare Interchange Inc. (the "Asset Purchase").

         6.  Evidence that all  conditions to the closing of the Asset  Purchase
have  occurred  and all  documents  and  agreements  required  thereby have been
executed and delivered

D.       MISCELLANEOUS.

         1. This Amendment may be signed in any number of counterparts,  each of
which shall be an original,  with same effect as if the  signatures  thereto and
hereto were upon the same instrument.

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         2. Except as herein  specifically  amended,  fill terms,  covenants and
provisions  of the Credit  Agreement  shall  remain in full force and effect and
shall be performed by the parties  hereto  according to its terms and provisions
and all  references  therein or in the Exhibits  shall  henceforth  refer to the
Credit Agreement as amended by this Amendment.

         3. This Amendment shall be governed by and construed in accordance with
the laws of the State of New York.

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         IN WITNESS WHEREOF, the parties hereto have executed and delivered this
Amendment as of the date first written.

                            MEDE AMERICA CORPORATION

                                       By:

                                                     ---------------------------
                                     Title:

                                                        ------------------------

                         BANK OF AMERICA NATIONAL TRUST

                                                  AND SAVINGS ASSOCIATION

                                       By:

                                                     ---------------------------
                                     Title:

                                                        ------------------------

ACKNOWLEDGED AND AGREED:

WELSH, CARSON, ANDERSON & STOWE V, L.P.

By:      WCAS V PARTNERS

         Its General Partner

         By: 

             -----------------------------------
             Its General Partner

WELSH, CARSON, ANDERSON & STOWE VI, L.P.

By:      WCAS VI PARTNERS

         Its General Partner

         By:                                                                 

             -----------------------------------
               Its General Partner

WILLIAM BLAIR LEVERAGED CAPITAL FUND
LIMITED PARTNERSHIP

By:      WILLIAM BLAIR LEVERAGED CAPITAL
         MANAGEMENT, L.P.

         By:      WILLIAM BLAIR & COMPANY,

                  General Partner

                  By:                                                         

                     -----------------------------------


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WILLIAM BLAIR CAPITAL PARTNERS V, L.P.

         By:      WILLIAM BLAIR CAPITAL PARTNERS, LLC,

                  General Partner

                  By:                                                          

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