Healthcare Digital Transformation: Considering the System Japan Truly Needs

Society Health Technology## Leading in Tech, Lagging in Application

I place a compact fetal monitor on the expectant mother’s belly and tell her: “Here, have a listen to your baby’s heartbeat.”

The expressions of everyone in the clinic change instantly. This is not Japan. It’s a remote village, hours from the nearest hospital, where no doctor is permanently stationed, in a country where childbirth can still cost a woman her life.

The heartbeat appears on the screen as a waveform. The data is transmitted to a physician in a distant location who reviews it and, if necessary, instructs the patient to be transported to a hospital. It’s a simple process, but one that can mean the difference between life and death for both mother and child.

As the founder of Melody International, I have been involved in perinatal healthcare in Japan and overseas through our mobile fetal monitor, iCTG, and our e-health platform. Whether I’m in Bhutan, Thailand, Brazil, African countries, or back at home in Japan, on one of its remote islands or mountainous regions, I find myself asking the same question: What prevents essential healthcare from reaching those in need?

There is another question that equally occupies my thoughts: Why is Japan struggling with the digital transformation, or DX, of its healthcare systems, despite the country’s technological sophistication?

It’s not as though Japan has made no effort. The Ministry of Health, Labor, and Welfare has been promoting a national medical information platform, services for sharing electronic health record information, and electronic prescriptions. In the case of electronic health records, adoption has increased year by year, and according to , 77.7% of hospitals and 71.0% of clinics had adopted them.

Even so, compared with countries such as Estonia and Denmark, where medical information is shared nationwide, Japan’s progress appears slow. According to , electronic medical record adoption had reached 85%–100% of hospitals and 80%–99% of general practitioners in the United States, Britain, Sweden, and Singapore.

Why does it feel, from the perspective of those working in healthcare, that Japan’s digital transformation isn’t moving forward?

My answer is that this transformation is not just about technology—it is also a matter of trust, responsibility, and the burden placed on frontline healthcare workers.

Excellence of Japanese Care Makes Change Difficult

Japan’s healthcare system maintains a high standard of quality within a detailed and complex framework that covers diagnosis, testing, record keeping, explanations, billing, and administrative procedures. The excellence of this system is itself what gets in the way of DX.

Viewed from outside Japan, paper medical records, fax machines, telephone calls, and handwritten referral letters may seem outdated and inefficient. But these practices are part of a system that healthcare professionals have built up over decades to ensure safety and reliability. DX is therefore not simply a matter of making things more convenient by introducing a new system.

If physicians must spend more time operating new systems and entering data, they inevitably have less time to spend caring for their patients. A found that 54.2% of medical clinics believed adopting electronic health records was not feasible. The most frequently cited reasons were that it would cost too much and that it would consume too much time, reducing the time available for patient care.

In healthcare, preventing mistakes takes priority over convenience. What may appear to be resistance to change is, in reality, the caution that comes naturally to professionals entrusted with people’s lives.

This is why it’s dangerous to dismiss Japan’s slow healthcare digital transformation, such as by simply blaming it on the JMA’s resistance, strict privacy regulations, or lack of IT talent.

Where Transformation Is Needed Most

Pregnancy and childbirth are not illnesses. but they are unpredictable situations that can quickly become medical emergencies. A fetus may develop heart rate abnormalities. An expectant mother may experience high blood pressure, bleeding, or premature labor. In these situations, a delay in judgment can mean the difference between life and death.

Obstetricians and midwives are not always evenly distributed across a given region. Even in Japan, the consolidation of maternity services has resulted in some expectant mothers in less populated areas having to travel long distances to reach a delivery facility. Elsewhere in the world, many women do not even have access to routine prenatal checkups.

The solution is not to build a large hospital in every village. Rather, what is needed is a system in which local midwives and nurses perform examinations and doctors who are farther away check the data and promptly make the necessary judgements.

That was the idea behind Melody International’s iCTG. By using portable devices connected through the cloud in place of the large fetal monitors available at hospitals, we enable trained healthcare workers to perform examinations anywhere while allowing physicians to evaluate fetal heartbeats remotely. This innovation is not just about downsizing equipment, but about changing how healthcare is delivered.

“Healthcare digital transformation” has the ring of a major systemic reform. Large-scale data platforms, standardization, AI, electronic medical records, and in the case of Japan the My Number taxpayer and personal identification system all play important roles. But from the perspective of those working on the front lines of healthcare, the breakthrough point has to do with something more precise: extending the reach of medical professionals beyond current limitations.

There is a limit to how many expectant mothers a single obstetrician can care for. But through remote monitoring and review of critical information, support can reach far more patients. If midwives can conduct examinations in their local communities and physicians make medical judgments remotely, pregnant women will not have to travel for hours just to get necessary checkups. DX of this sort, rather than replacing medical workers with technology, uses technology to extend their expertise to wherever it is needed.

In my view, this understanding is key in advancing healthcare transformation in Japan.

Don’t Wait for Perfection

Japan is a country that designs its systems with great care. That is one of its strengths. At the same time, it can become a weakness if we avoid moving forward until every detail has been perfectly worked out.

Healthcare DX faces the same challenge. We tend to wait until standards have been specified, subsidy programs are in place, and responsibilities have been clearly defined. Safety and institutional frameworks are of course indispensable. But the realities of healthcare do not wait for perfect conditions.

Even today, expectant mothers are not free of anxiety, and places where physicians are lacking have no option but to offer care with limited personnel. In this respect Japan does enjoy advantages over developing countries, where there are still mothers and babies who lose their lives before ever reaching a hospital, but regional disparities do have an impact domestically as well.

That’s why we must do more than pursue a single, nationwide model. We need to build on small success stories in individual communities and foster a system that will actually be useful to remote islands, mountainous regions, areas with shortages of obstetricians, and communities where midwives play central roles—a system that doctors will embrace and patients will trust.

Digital transformation isn’t complete immediately after a new system is introduced. It takes root only after people use it, improve it, and come to rely on it.

A Model Japan Can Share with the World

Personally, I do not believe Japan will continue lagging behind in healthcare DX. On the contrary, I believe we have the potential to show the world a different path forward—one that views this transformation as more than a quest for efficiency and optimization.

While connecting healthcare data is important, we must never forget that behind the data there are real people—pregnant women, infants, and concerned family members, not to mention the doctors reviewing the data in the night and midwifes travelling in remote communities.

Japan’s healthcare system has always valued the warmth of human care. If we can preserve that human touch while using technology to strengthen it, Japan can offer the world a meaningful DX model.

Problems such as aging populations, shortages of physicians, and regional disparities are not Japan’s alone. Solutions developed in underpopulated areas of Japan could help improve healthcare in underserved regions around the world.

The breakthrough in Japan’s healthcare DX will not come solely from some vast, nationwide digital infrastructure built in the future. The key is already here with us, beside healthcare professionals and expectant mothers, and in the heartbeat of babies before they come into the world crying. Building a society where that heartbeat can be heard wherever a mother may be is the foundation of the healthcare digital transformation I envision. It is also the kind of approach to healthcare that Japan can offer to the world.

(Originally published in Japanese. Banner photo: Medical staff provide perinatal medical care with an iCTG unit in Chiang Mai, Thailand. Courtesy Melody International.)