The Value of Digital Ecosystems and How You Build Them

Randy Horton

Published on: January 6th, 2026

What Digital Ecosystem Means in MedTech

A digital ecosystem is the connected environment built around a medical device that creates value across the product’s lifecycle for the manufacturer, patients, and clinicians. It encompasses the device and digital layers surrounding it, such as mobile applications, Bluetooth or Wi-Fi connectivity, cloud backends, software services, and integrations with third-party data or systems. Ecosystem boundaries are often fluid. A single device may be in multiple ecosystems at the same time, both those that a company builds and those that already exist in patient or hospital technology environments.

Some companies build their digital ecosystems. Others design products to operate within established ecosystems, such as smartphone platforms used by patients or hospital technology environments. Most manufacturers use a combination of the two approaches.

“Don’t think of it as one ecosystem, think of it as potentially the interplay of different ecosystems that you are either creating or that you are becoming a part of.”
— Bernhard Kappe

This approach is now possible because computing power, sensor technology, connectivity, and cloud infrastructure have matured. These foundations allow companies to layer digital capabilities onto tools people already use, making continuous engagement, real-time feedback, and remote visibility practical rather than aspirational.

When Ecosystems Are Essential and When They Are Not

Ecosystem strategy differs across MedTech categories. Whether a connected digital layer is needed depends on the intended use of the device, the market, and the timing.

Some clinical domains already require deep connectivity. Diabetes management is a clear example. Continuous glucose monitors, insulin pumps, and smartphones operate in tightly linked feedback loops that deliver alerts, visualize trends, and support automated therapy adjustments. In this space, a non-digital product is unlikely to be commercially viable.

Other areas are moving more gradually. Surgical specialties historically relied less on connected infrastructure. That is changing as surgical planning tools, intraoperative guidance systems, surgical robotics, and workflow software become more common. New generations of clinicians are trained inside digital environments and increasingly expect connected systems as standard practice.

At the same time, not every medical device must be integrated into one or more digital ecosystems on day one. For example, early-stage surgical tools may need to focus first on clinical validation and initial commercialization. Connected elements can follow as product lines mature and customer expectations evolve.

Across every scenario, one principle holds.

“At the end of the day, you have to have product-market fit.”
— Jenny Barba

Business Drivers Behind Connected Care

Connectivity in MedTech often starts with concrete business problems that need solving, rather than a desire to add digital features for their own sake.

Sleep-apnea CPAP devices became cellular-connected so manufacturers could prove patient usage for reimbursement and track leased equipment in the field. Connectivity solved reimbursement verification and asset-tracking challenges before it became part of a broader digital strategy.

Implanted sleep-therapy systems followed the same logic. Data and connectivity allow companies to demonstrate therapy effectiveness, which directly influences reimbursement decisions and long-term adoption.

The pattern is consistent. Connected ecosystems gain adoption when they solve reimbursement challenges, reduce operational burden, or generate the clinical evidence needed to prove that they actually improve patient outcomes. Digital investments pay off when they remove real obstacles for providers, payers, or patients, and not just when they look cool!

Data as a Strategic Asset

Connected systems change how MedTech companies generate, capture, and use data.

“Don’t treat data as exhaust, out of your system. Think about it and design that in, whether it’s your own data or other data that you could potentially be generating or capturing. That is one of the key parts of a digital ecosystem.”
— Bernhard Kappe

Devices on connected platforms generate continuous insight into device performance, patient behavior, clinical outcomes, and operational workflows. When data is designed into the product intentionally, it can create new value such as:

Identification of better surgical techniques
Personalized therapy adjustments
Improved rehabilitation planning
Operational efficiency in hospitals
Stronger evidence for reimbursement and adoption

When data strategy is ignored, those opportunities disappear. Treating data as an afterthought limits future service models, analytics capabilities, and long-term differentiation.

Ecosystems as Business Model Shifters

Some of the most compelling examples discussed were not incremental product improvements. Rather, they were fundamental business model changes made possible by connected ecosystems.

One medical device manufacturer cited in the webinar began by selling organ perfusion devices and struggled to scale. Growth accelerated when the company expanded into full organ transport and logistics services. That shift required software platforms, operational infrastructure, and coordinated data systems. Once those pieces were in place, the company moved from slow device sales to rapid growth and multi-billion-dollar scale.

Another company discussed in the webinar redesigned an in-clinic neuromodulation therapy so patients could complete treatment at home. Connected devices, remote oversight, and nurse-supported operations replaced the need for repeated office visits. Physicians reduced clinic burden, patients gained convenience, and revenue shifted from one-time device sales to recurring service delivery.

These examples illustrate a simple point. Digital ecosystems make service models operationally and financially viable where they were not before.

Surgical Ecosystems, Scale, and Market Dynamics

Large MedTech companies have invested heavily in surgical robots, planning tools, and imaging platforms. The next phase is connecting these assets into unified ecosystems.

These integrated environments enable end-to-end procedural workflows and centralized data capture. But they also require significant capital investment in robotic systems and operating room infrastructure. As a result, adoption is limited to large, well-funded hospitals.

This creates a market opening for newer companies. Solutions designed to work within standard surgical environments or to reduce infrastructure requirements can reach more sites and scale faster after product-market fit is achieved.

Building By Plugging In, Not Starting from Scratch

Digital ecosystems allow MedTech companies to accomplish more, faster, by leveraging functionality and value that already exist in surrounding ecosystems.

Patients already live inside smartphone platforms. Hospitals operate within established technology environments. Rather than rebuilding these foundations, companies can design devices and services that plug into existing systems, data flows, and workflows.

This approach allows early-stage teams to remain capital-efficient while still delivering connected products. Internal resources stay focused on core clinical and product development, while existing ecosystems provide distribution, connectivity, and supporting digital infrastructure.

The Technical Foundation Must Evolve

Connected ecosystems depend on software and cloud infrastructure that change quickly. So, for example, companies that adopted early cloud platforms and never updated them now face slow releases, rising development costs, and limited flexibility. In some cases, organizations “lifted and shifted” older technology into the cloud without changing how they actually build and ship software. Over time, each new release takes more effort, more people, and more coordination. Development slows instead of accelerating.

Modern software platforms are built to change often. They let teams ship updates quickly and continuously improve products. Older platforms were not built this way. When companies try to layer new digital ecosystems on top of outdated systems, development slows, and costs rise. That’s why many organizations need to review and modernize their technology foundations to keep digital products sustainable and to take advantage of the evolving nature of digital ecosystems.

Will Big Tech Own the Ecosystems?

A decade ago, many in MedTech worried that large technology companies would take over healthcare ecosystems. The assumption was that software giants would outpace traditional device manufacturers.

In the panelists’ opinion, the reality has been more balanced. Building medical devices, navigating regulation, and operating inside clinical workflows require specialized expertise. Large MedTech companies still hold advantages in clinical relationships, sales, and quality/regulatory infrastructures, and domain knowledge. Technology giants have more often become service providers within healthcare ecosystems rather than direct replacements for MedTech manufacturers.

The stronger force shaping the impact of big tech companies on healthcare is the basic facts of healthcare economics. Traditional hospital-based care is expensive and increasingly difficult to sustain financially. This is driving growth in remote care, service-based delivery models, and digitally enabled therapies. Companies that design technology to fit clinical workflows and reimbursement structures are best positioned to succeed in this shift.

What This Means in Practice

Build efficiency with intent. Ecosystems create value by removing friction, shortening paths to market, and supporting product-market fit rather than adding complexity.
Design for how people already live and work. Patients, clinicians, and new medical graduates operate inside digital environments and increasingly expect connected experiences.
Treat data as a first-class product decision. Design what data to capture and how to use it. Data enables learning loops and future value that may not be obvious upfront.
Pay attention to ecosystems outside MedTech. Observing everyday digital ecosystems sharpens intuition for what makes connected experiences valuable and sticky.

How Orthogonal Can Help

Building a digital ecosystem is not only a technology decision. It requires alignment across product strategy, data architecture, development practices, and regulatory execution. Orthogonal helps MedTech companies turn ecosystem ambition into practical, compliant delivery.

Turn ecosystem strategy into buildable plans.

Translate ecosystem vision into clear roadmaps across devices, apps, cloud services, and data flows aligned to stage and product-market fit.

Modernize development foundations.

Adopt cloud-native practices that support rapid releases and continuous improvement rather than accumulating new technical debt.

Design data in from the start.

Define what data to capture, how to structure it, and how to operationalize it so data becomes a long-term asset rather than overlooked exhaust.

Align speed with regulatory discipline.

Blend modern software development with MedTech safety and design-control expectations so teams move faster without losing compliance or trust.

Right-size ecosystem scope.

Decide what to build now, what to partner for, and what to phase later to remain capital-efficient.

Watch Webinar Recording

Randy Horton, VP of Solutions and Partnerships, Orthogonal