There is a growing interest in the use of digital technologies to create new roles and relations between health professionals and patients. This technology-enabled transformation extends the traditional interactional way to deliver healthcare services, which has been historically grounded for over 100 years. A compelling argument for this interest is that for many diseases, not least for chronically ill persons for whom the majority of practices related to treating their medical condition is carried out in their home, there is a space for healthcare service delivery that is largely invisible for the healthcare provider. Swedish healthcare is currently finding ways to adopt and utilize self-monitoring as an integral part of healthcare services. Even though there is consensus among many stakeholders that self-monitoring can be a potentially transformative force, the speed of transition is slow. The evolving phase of the healthcare service ecosystem becomes interesting to investigate and how a variety of institutional logics shape the future of the digitally engaged patient. A service ecosystem has previously been defined as “a relatively self-contained, self-adjusting system of resource-integrating actors connected by shared institutional arrangements and mutual value creation through service exchange” (Vargo and Lusch, 2016, p.10). By applying institutional theory to the case of self-monitoring in Sweden, we are responding to the call in service science to contribute to a better understanding of the service ecosystem of healthcare and what facilitates and constrains the changing roles of its actors in value creation. The purpose of this study is therefore to better understand the shift from the view of patients as passive receivers of care into being active co-producers that takes part in decision-making and in the care delivery through self-monitoring. Taking an institutional logic approach, the authors identify key “roles” (subjects), “materials” (objects) and “practices” (ways of acting) in the healthcare service ecosystem that facilitate and constrain the emergence of self-monitoring technologies. To do so, the study draws on multiple sources of evidence. First, 20 interviews have been conducted with respondents representing various key actors in the healthcare service ecosystem (e.g., health-care professionals, patient organizations, hospital managers, policy officials, pharma industries and information officers). Second, we observed a development project where new self-monitoring systems were piloted in cancer care. Our study offers several important implications for service theory and management. For service theory, this study shows how alignment and misalignment between practices, roles and materials facilitate and constrain the emergence of self-monitoring technologies within the health service ecosystem. For service management, this study raises four barriers – conflicts, compliance, lack of knowledge and appropriate technologies - that are crucial to overcome when implementing self-monitoring technologies