Electronic prescriptions launched in January 2023, and more than three years have passed. Yet adoption among medical clinics stood in the low 20% range as of early 2026—lagging among the major Medical DX measures. This article organizes the policy aim behind electronic prescriptions, the structural reasons adoption has been slow, and the outlook. For practical matters such as adoption steps, costs, and subsidies, see What Is an Electronic Prescription? Benefits, Costs, and How to Proceed.
Disclaimer: This article is general information. Figures such as adoption rates vary by point in time, and the treatment of subsidies and fees may change through revisions and notices. In practice, always confirm the latest primary sources (MHLW, the Comprehensive Portal Site for Medical Institutions, and others).
For the overall map of Medical DX, see What Is Medical DX? The Government Roadmap and Its Three Pillars.
The Policy Aim Is Not "Eliminating Paper"
Electronic prescriptions are often understood as replacing paper prescriptions with electronic ones. But the policy focus lies elsewhere: creating a state in which prescribing and dispensing information is managed centrally nationwide and can be referenced in real time.
What this seeks to achieve:
- Checking duplicate prescribing and contraindicated combinations: confirm on the spot what was prescribed at other clinics and pharmacies, preventing dangerous combinations and wasteful duplication
- Addressing polypharmacy: grasp the full prescribing picture for older patients who visit multiple institutions
- Understanding drug supply conditions: as prescribing and dispensing data accumulates, the real situation during supply disruptions becomes visible
You can hand a patient a paper prescription, but you cannot see what was prescribed elsewhere. Resolving that information asymmetry is the essential value of electronic prescriptions.
Its Place in the National Medical Information Platform
Electronic prescriptions run on the online eligibility verification network. In other words, the Myna insurance card and online eligibility verification spread first, and electronic prescriptions were the first substantial service to ride on that plumbing.
| Layer | Content |
|---|---|
| Foundation | Online eligibility verification network (eligibility information) |
| First layer | Electronic prescriptions (medication information) |
| Second layer | EMR Information Sharing Service (clinical information) |
Seen in this order, it becomes clear that lagging adoption of electronic prescriptions can also affect the effectiveness of subsequent measures.
Why Adoption Has Been Slow
Several factors compound to hold adoption back.
1. The "Two Wheels" Problem Between Clinics and Pharmacies
Electronic prescriptions deliver value only when both the prescribing institution and the dispensing pharmacy support them. At clinics that mainly prescribe for outside dispensing, the system is effectively unusable unless nearby pharmacies support it—and vice versa. When both sides decide to "wait for the other," diffusion stalls.
2. The HPKI E-Signature Hurdle
Electronic prescriptions require a physician's electronic signature (HPKI). Applying for the card, renewing it, and handling it day to day—managing the card, performing signature operations—are steps that paper prescriptions never involved. Lead time to obtain a card has also been raised as an issue.
3. Adoption Costs and Operational Change
Beyond system modification costs, operations must be revisited at reception, consultation, and checkout. Subsidies have been provided, but many still find it hard to identify a reason to act right now.
4. The Benefits Are Hard to Feel
While support rates are low, the prescribing information available to reference from other institutions is also limited. The structure invites a loop in which lower diffusion means lower value, and lower value means less diffusion.
Where Policy Support Stands
Against this backdrop, policymakers continue steering through both the fee schedule and subsidies.
- Evaluation through the fee schedule: support for electronic prescriptions is built into the facility standards of the electronic clinical information coordination fee. Billing the addition presupposes having adopted electronic prescriptions
- Subsidies: support programs for adoption costs have been established. Requirements, subsidy rates, and application windows change by fiscal year, so check the latest announcements
The structure—"not mandatory, but there is an addition you cannot bill without it"—mirrors the Myna insurance card. Substantive steering through the fee schedule, rather than a statutory obligation, has been used consistently as the policy instrument.
How Clinics Should Decide
If You Mainly Prescribe for Outside Dispensing
Start by checking the status of nearby pharmacies. If the pharmacies you work with most already support it, the benefits appear sooner. And if you intend to bill the electronic clinical information coordination fee, support is a prerequisite.
If You Mainly Dispense In-House
The direct benefits are relatively smaller, but being able to reference other institutions' prescribing information still has clinical value. The decision will hinge on the addition's requirements.
If You Are Due to Update Your EMR
Support depends on your EMR/rececon's capabilities. If you are considering an update or switch, choosing a product that already supports it at that moment minimizes the burden.
Outlook
Electronic prescriptions gain value in combination with the EMR Information Sharing Service, because only when clinical and medication information are both present can you grasp the whole patient picture. As policy, the direction of raising adoption—through stronger addition requirements and subsidy support—is likely to continue.
Institutions should note that "waiting because it has not spread yet" can itself forfeit opportunities to bill the addition.
With AI Karte
The AI-native EMR "AI Karte" is designed to support Medical DX mechanisms such as online eligibility verification and electronic prescriptions. With an integrated rececon, prescribing through billing is handled on one foundation, keeping in-house operational changes minimal when adopting electronic prescriptions. We are happy to discuss satisfying the electronic clinical information coordination fee's requirements at adoption.
Conclusion
The essence of electronic prescriptions is not replacing paper but making prescribing and dispensing information referenceable nationwide. Adoption lags because several factors compound—the two-wheel structure between clinics and pharmacies, the effort of HPKI, and the loop that makes benefits hard to feel—which is in part an inevitable consequence of the design. Practically, clinics should decide timing by weighing three things: the status of nearby pharmacies, their policy on billing the addition, and when their system is due for renewal.
Through providing AI Karte, Pottech aims to be the ideal business partner for clinics—improving the working environment for physicians, nurses, and medical clerical staff, and supporting clinics in fully realizing what they want to achieve.
For more details, please feel free to contact us.