So we just attended DMEA 2026, which is a large medtech conference in Berlin, and we had a great time! As we're a remote company, it's always great to get together in person, and attending a conference while experiencing the "real medtech world" (vs. staring into our computer screens) was lots of fun.
Here's my favorite conversation from the conference. A dude was talking to a dudess at her booth, and I walked up and did the awkward thing of "I will just stand here next to two talking people at a conference and hope that they will somehow include me in their social interaction soon".
Here's what they were talking about:
Here's my favorite conversation from the conference. A dude was talking to a dudess at her booth, and I walked up and did the awkward thing of "I will just stand here next to two talking people at a conference and hope that they will somehow include me in their social interaction soon".
Here's what they were talking about:
- "Well, the whole DiGA model is tricky, but it's working for us, which is cool."
- "Yeah, I hope it'll work for us too, we'll be going for approval soon"
Neither of the two humans has so far have made any effort to involve me in this interaction. - "But, well, the coolest and simplest way to get the regulatory stuff done nowadays is to use the OpenRegulatory FRAMEWORK, right?"
Both humans turn to me.
My mind was blown: 1) The two humans had noticed my presence, 2) they actually knew who I was, 3) OpenRegulatory had become a legitimate business and household name in the medtech world while no one told me about this, and 4) Formwork continues to be a suboptimal product name as people tend to call it "Framework".
So that was cool. Enough of the self-promotion though now. I came away with some thoughts from DMEA and I thought I'd share them with you. As always, some are rants, some are controversial, and some are hopefully interesting for you.
Is The DiGA Model Finally Dead?
Remember when back in the stone age (2020) "prescribable apps" were the new hot thing in Germany? Turns out that most of those business models didn't pan out, surprise surprise. I noted this back in 2023 and again in 2025, and the main comments on LinkedIn at the time were people suggesting that 1) I'm clueless, 2) I'm only attention-farming, 3) we just need more time and 4) by the way we offer DiGA consulting, contact us and pay us lots of money to launch your DiGA.
So let's revisit this in 2026 by paraphrasing / anonymizing their viewpoints, their job positions, and their company profitability - yeah, you know where this is going:
So let's revisit this in 2026 by paraphrasing / anonymizing their viewpoints, their job positions, and their company profitability - yeah, you know where this is going:
- "I disagree"
Person who works at a software development agency whose main clients are future DiGA manufacturers. - "You're wrong"
Founder of a DiGA company (€1M - €6M in yearly losses since 2020). - "No, the DiGA bubble is not bursting, we just need more time"
Person who worked at a DiGA manufacturer (now works as a consultant to "help companies increase revenue")
So it's fair to say that the people being pathologically optimistic about the DiGA model are either 1) DiGA consultants in search of new DiGA consulting clients because that's the way they make money, or 2) DiGA founders in search of new investors because that's the way they prevent their company from running out of money.
Looking at the actual financials of a representative DiGA company paints a bleak picture - millions of losses every year:
Now, the obvious counterargument to this, just like the consultants on my LinkedIn post might state, would be that I don't understand the way of how a VC-funded DiGA company works, making millions in losses is totally by design (for how long?), and with sufficient scale (what sort of scale?), the company will magically become profitable and everyone will live happily ever after.
Maybe.
I indeed have no clue about building and running a VC-funded company. For me, as an old-school German "Mittelstand" dinosaur teleported into the young body of a 36-year old half Asian dude, the definition of a successful business includes the fact that the business is making money, as Peter Drucker (another dinosaur business dude) notes in his books.
So yeah. Regardless of how you think a business should be built, it's fair to make the observation that:
- Existing DiGA companies are struggling hard and either going bankrupt or looking for a mediocre exit to a pharma company;
- Hardly any new DiGA companies are being founded right now;
- All sorts of consultants are still around and happy to benefit as middlemen.
And, interestingly, this was exactly mirrored at the DMEA conference. Subjective observations:
- Slightly more "middlemen" booths: Regulatory consultants, DiGA consultants, lawyers, software development agencies.
- Hardly any booths of new DiGA startups.
- Hardly any booths of existing DiGA companies (!).
My personal conclusion of the DiGA space is that:
- The default assumption that "it doesn't work" is a good starting point.
- It can work if:
- Your goal is to build a small (3-10 people), profitable company with no investors or investors who don't expect a huge exit + return on their investment;
- You are piggy-backing off the in-person sales team of a pharma company which spends lots of time visiting doctors and "recommending" them to prescribe your medication (and now, DiGA).
- Besides that, the overall increase in regulations (BSI etc.) however make it increasingly hard to enter this space at all.
Would I build a DiGA company nowadays? Nope. For my taste, it's hopelessly over-regulated.
In a perfect world, health app companies would compete in a free market and patients would vote with their wallets. I do see the counterpoint to this that German people are uniquely conditioned to not pay cash for any sort of healthcare at all. I'm not sure what the solution to this might be, but the DiGA model increasingly doesn't look like it.
But luckily, we have the new Next Big Thing which is not regulated (at all?) yet - medical scribes.
Medical Scribes Are The New DiGAs
I briefly made inadvertent contact with a VC investor dude while raiding the evening finger food at one of the booths (VC dude: "I messaged you on LinkedIn, but you never responded"). I managed to defuse the situation somehow and strike up a normal-sounding conversation. The dude shared one interesting observation: Among VC investors, medical scribe startups are the only super-hyped thing nowadays, because they have huge revenue potential as pretty much any hospital and doctor's office is a potential customer.
And the booths at DMEA indeed showed this - medical scribe companies had disproportionately large booths, and accordingly lots of investor money.
What struck me was that I had talked to some medical scribe company 1-2 years ago and didn't really get the impression that those companies were being built by particularly (technically) proficient people (no offense). So I guess you could either have the hypothesis that the market is so "full of revenue potential" and so large that it won't depend on founder skill very much, or you could have the hypothesis that we're seeing a mini-bubble, just like how Covid times ploughed lots of money into various startups whose main asset was a PowerPoint presentation.
I'm leaning towards the latter.
I've been part of three large hypes in Healthtech: Radiology AI (2018), DiGAs (2020) and now medical scribes (~2025). To be fair, my gut feeling as a doctor is that medical scribes might indeed provide the most value to physicians. But it will really, really depend on how well this whole concept will be executed. We will see. I'm looking forward to hearing the real-world experiences of my doctor friends.
And the booths at DMEA indeed showed this - medical scribe companies had disproportionately large booths, and accordingly lots of investor money.
What struck me was that I had talked to some medical scribe company 1-2 years ago and didn't really get the impression that those companies were being built by particularly (technically) proficient people (no offense). So I guess you could either have the hypothesis that the market is so "full of revenue potential" and so large that it won't depend on founder skill very much, or you could have the hypothesis that we're seeing a mini-bubble, just like how Covid times ploughed lots of money into various startups whose main asset was a PowerPoint presentation.
I'm leaning towards the latter.
I've been part of three large hypes in Healthtech: Radiology AI (2018), DiGAs (2020) and now medical scribes (~2025). To be fair, my gut feeling as a doctor is that medical scribes might indeed provide the most value to physicians. But it will really, really depend on how well this whole concept will be executed. We will see. I'm looking forward to hearing the real-world experiences of my doctor friends.
Another Hype: Discharge Management
Another huge hype which totally went past me was discharge management. To be fair, I am genuinely uninformed about this topic, so I don't have any observations to add. I just noticed it is huge - there are apparently some financial incentives to hospitals to offer these sort of products.
My main interesting finding here was that a much-hyped company, Recare, was actually deeply unprofitable (€3.5M losses in 2024), whereas a smaller company, Entlassmanager, with a much-less-shiny website, was actually profitable, with €755k profits in 2023. Interesting.
So, at the very least, this looks like an area in which actual profitable companies can be built (and there's probably also some lesson here about fancy businesses with lots of LinkedIn activity and huge conference booths often not being profitable).
But then again, I do have to repeat the disclaimer that my knowledge in this area is limited.
My main interesting finding here was that a much-hyped company, Recare, was actually deeply unprofitable (€3.5M losses in 2024), whereas a smaller company, Entlassmanager, with a much-less-shiny website, was actually profitable, with €755k profits in 2023. Interesting.
So, at the very least, this looks like an area in which actual profitable companies can be built (and there's probably also some lesson here about fancy businesses with lots of LinkedIn activity and huge conference booths often not being profitable).
But then again, I do have to repeat the disclaimer that my knowledge in this area is limited.
Regulatory Tech Startups With VC Investment
I had the opportunity to talk to some of our Formwork (not Framework) competitors in the regulatory software space. We all concluded that scaling a regulatory software is viable, but the growth rate is slow. That's totally fine if you're 100% founder-owned and profitable like we are, but it's probably totally not fine if you've received VC investment and your VC investors are breathing down your neck and expecting some crazy growth rate so that they can sell your company in 3 years at 100x its prior valuation. I felt a bit sorry for those people. I guess it's one more data point that VC investment is often not a positive thing, as I wrote here back in 2023.
Fewer Startups?
The biggest take-away however was that I thought there were "fewer startups", even though this was non-obvious and hard to define: The startup areas were similarly sized like the prior years. The amount of new startup booths was roughly the same. Still, I felt like there was less. What had changed?
Roughly simplified, in the past, the startup areas were full of companies "actually building things": Back in 2017 (!), I even manned a booth at a then-startup I was working for which was developing an electronic patient record app for patients. And that was the spirit of those times: Aim to build great things, even though many of those bets are likely not going to pan out. Or at my next job, where one of our ideas was to build a new, AI-powered radiology image viewer. That was cool.
Now, in 2026, I got the feeling that the bets had gotten way smaller. First off, there were way fewer startups actually building things - many booths in the startup area now could be summarized as "middlemen":
Roughly simplified, in the past, the startup areas were full of companies "actually building things": Back in 2017 (!), I even manned a booth at a then-startup I was working for which was developing an electronic patient record app for patients. And that was the spirit of those times: Aim to build great things, even though many of those bets are likely not going to pan out. Or at my next job, where one of our ideas was to build a new, AI-powered radiology image viewer. That was cool.
Now, in 2026, I got the feeling that the bets had gotten way smaller. First off, there were way fewer startups actually building things - many booths in the startup area now could be summarized as "middlemen":
- Consultants: Regulatory, clinical, reimbursement (DiGA), etc.
- Agencies: Software development, clinical trials, etc.
- Infrastructure: Electronic health record "glue code" (FHIR), etc.
Few remaining startups were actually building things. And if they were, their bets had gotten way smaller. Instead of building a new electronic health record or a new radiology platform, they were developing small software components, likely hoping to sell those to a larger enterprise later on.
I was joking to my colleagues that, if this were a space exploration / rocket conference, all the startups were trying to build one tiny device which they were hoping to attach to the final space ship, but none of the startups was actually building the space ship.
DMEA 2026 felt the same. That made me a bit sad, because it looked like no one was aiming to build big things any more.
