This PhD thesis examines nascent digital innovation ecosystems in the healthcare sector, drawing on process-based approaches through a longitudinal qualitative field study. I ask the following overarching research question: How are digital innovation ecosystems orchestrated in the healthcare sector? I develop novel insights through a combination of semi-structured interviews and observations at field configuring events pertaining to the early DTx community and a first mover digital medicine start-up, SensorCorp1. SensorCorp invented the first ingestible biosensor that monitors adherence to prescription medication regimens (pills). This thesis focuses on two specifics areas of the DTx innovation phenomenon.

Firstly, this thesis examines the emergence of a nascent innovation ecosystem characterized by points in time where fundamental and irreversible changes occur, what has been termed turning points – abrupt moments of change that give rise to a new reality. Turning points involve the mutual constitution of the innovation trajectory and broader entrepreneurial trajectory dynamics and provides a temporal perspective on ecosystem emergence. Through my findings, I characterize turning points in the innovation context as a kairotic redirection that has decisive implications for value creation, the progression of an ecosystem, and by extension, its innovation trajectory. Secondly, this thesis addresses the inherent challenges of innovating when collaborating industries stem from divergent epistemic cultures – pharmaceuticals and technology. My findings show that in order for DTx products to enter a space historically occupied by pharmacological products, the emerging DTx community would need to negotiate and rationalize epistemic disunity across six dimensions and develop the concept of epistemic mirroring, which is the purposeful adoption of key knowledge production mechanisms in alignment with a particular epistemic culture to sculpt, legitimize, and establish a new type of innovation within a broader ecosystem.