Connected Therapeutic Devices

FDA Clearance Gets You to Market. The Connected System Earns It.

A therapy only works if patients stay on it and you can prove it. We design and engineer the connected systems behind implantable and body-worn therapies, with electronics, embedded, mobile, cloud, and security under one team.

Discuss your program's needs
Vignette Therapeutics Dark

What Sets Us Apart

One Team Across Every Layer
No vendor fragmentation, and no integration gaps at the seams.
Implantable and Wearable Systems
Neuromodulation, drug delivery, hearing systems, and more.
Built for FDA Class II and III Programs
Architecture designed around your regulatory pathway from day one.
Cybersecurity Built Into Architecture
Section 524B obligations engineered into the system, so cybersecurity doesn't slow submission.

The Connected Medical System

A Therapeutic Device Is One Component of a Five-Layer Connected System.

Most of what makes a connected therapeutic device work sits outside the device itself. The device is the layer that acts on the patient, so every setting a clinician sends to it and every reading it returns carries clinical weight.
Each layer has its own performance, security, and documentation requirements, and the most consequential faults happen where two layers meet. We build all five, so the engineers who design those meeting points are the engineers building the layers on either side.
Hero Homepage Varmobile
1
The Device
Electronics and embedded software delivering therapy in real time.
2
The Wireless Link
BLE or near-field RF that carries commands and patient data, subject to wireless certification.
3
The Companion App or Gateway
The patient-facing interface and the communication bridge between device and cloud.
4
The Cloud Platform
Data infrastructure, remote therapy management, and post-market support.
5
The Clinician Interface
Therapy programming, patient monitoring, and clinical management.

WHAT WE SOLVE FOR

The Failure Modes We Prevent Start Early.

They live at the seams between layers, vendors, and parallel tracks that never sync. These are the six we see most.

EXPAND ALL
Integration Challenges Icon

The Integrated System Gap

The layer a team has never shipped is the one it can't assess. On a five-layer system, most teams are deep in one and lighter in the rest.
Why It Happens
Depth in one layer doesn't transfer. A firmware team that has never built a regulatory-compliant mobile and cloud stack doesn't know where its assumptions break, and no one on the program owns the view across all five.
What it costs
Cross-layer risks never make the test plan. The integrated system ships with failure modes the team never thought to test for.
Architecture Challenges Icon

Architecture Decisions Made in Isolation

Wireless protocol, chipset, and mechanical envelope read as engineering choices. Each one limits therapy delivery, clinician workflow, and what the submission can support.
Why It Happens
The decision looks technical, so engineering makes it on its own inputs. The clinical, human factors, and regulatory consequences are real but downstream, and nobody on the program is responsible for flagging them at the point of decision.
What it costs
The consequences surface at human factors validation, regulatory review, or in the field. Fixing them means a second architecture decision made under deadline, undoing months of engineering built on the first.
Security As Documentation Challenges Icon

Security Treated as a Documentation Exercise

Security work starts when the submission process demands it, long after the architecture is locked in place.
Why It Happens
524B reads as a filing obligation, so the work lands with whoever owns the submission instead of whoever owns the architecture. But whether the device is secure was decided in that architecture, in the update path, the interfaces between subsystems, and how components authenticate each other.
What it costs
Gaps surface at submission, and the fixes cut against years of settled architecture. What should have been a design input becomes structural rework at the point in the program least able to absorb it.
Partner Fragmentation Challenges Icon

Partner Fragmentation at the Seams

Nobody tests the seams between vendors until the pieces have to work as one device. Each one tests against its own contract.
Why It Happens
A contract defines a deliverable. It says nothing about the assumptions the next team is building on. Firmware's timing assumptions and mobile's connection-state assumptions can both be correct and still not match.
What it costs
You inherit the integration risk you thought you'd outsourced. The failures have no owner, every vendor delivered to contract, and the fix means renegotiating scope on a schedule that's already moving.
Connected System Verification and Validation Challenges Icon

Connected System V&V Starting From Zero

Validating a therapy and validating the connected system delivering it are different disciplines. Most programs are staffed for the first one.
Why It Happens
The therapy has a well-understood validation path. Proving firmware, wireless, mobile, and cloud hold up together under dropped connections, low battery, and concurrent users has none. No traceability, no test infrastructure to extend, and a team doing it for the first time.
What it costs
A connectivity drop or firmware fault that corrupts therapy delivery has nothing in place to catch it. Standing up system V&V becomes an unplanned program of its own, inside a timeline that never accounted for it.
Design History File Challenges Icon

The Design History File Is Built After the Fact

The file is supposed to be the record of a controlled process. Assembled at the end, it's a reconstruction of one.
Why It Happens
Partners treat design controls as paperwork to close out at the end instead of a controlled process the work runs under. While decisions are being made, capturing the reasoning behind them is nobody's job.
What it costs
A reconstructed file can't serve its purpose. Gaps in user needs, risk analysis, and design verification surface under inspection, when a finding can hold up approval.
Every layer of a connected system has an owner. The system itself rarely does, so we own it by building it with you, layer by layer.
Tell Us About Your Challenge

Regulatory & Compliance

We Build Inside the Regulatory Environment. It Shapes How We Work.

We treat regulatory strategy and architecture as one design problem, and three commitments make that integration durable rather than declarative.
An illustration of series of documents representing key security and design controls with accompanying checkmarks.

SECURITY & DESIGN CONTROLS

Regulatory strategy baked into architecture from day one.

Security designed at the system level. 524B documentation generated as part of development. Design controls reflect an actual controlled process because the process was controlled from the start.

DECISION INPUTS

The right perspectives pulled into decisions early.

Some engineering decisions carry human factors, clinical, or regulatory weight, and we know which ones before they’re made. We pull those inputs in at the decision point, from your team, your advisors, or partners we recommend, so the work holds up at validation and review.

An illustration of a bunch of decision input arrows all converging upon a single check mark.
An illustration of a hand holding a magnifying glass and following a weaving path of check marks.

TRACEABILITY

Verification evidence built alongside the system.

Requirements trace to tests, automated and manual, across every layer as the system comes together. When your team runs system-level V&V, they start with working test infrastructure and coverage at the seams rather than building it from scratch.

The result is a device engineered for clinical use and regulatory submission simultaneously, which prevents the late-stage rework that comes from treating regulatory work as documentation applied after engineering is done.

Regulatory & Standards

Every requirement engineered into the architecture.

FDA Submission Pathways 
510(k)
for Class II devices
Premarket Approval (PMA)
for Class III devices
De Novo
for novel low-to-moderate-risk devices
Investigational Device Exemption (IDE)
for clinical investigation of an unapproved device
Early Feasibility Study (EFS)
for early, first-in-human studies
FDA Cybersecurity (Section 524B)
Cybersecurity-by-Design 
as a premarket submission requirement under FDA's February 2026 final guidance
Secure Product Development Framework
for system-level threat modeling and architecture decisions
Secure Communication, OTA Updates, SBOM, and Vulnerability Management
at the connectivity and software level
Aligned with IEC 81001-5-1
Security across the health software lifecycle
Software, Safety & Quality Standards
IEC 62304
Medical Device Software Lifecycle
ISO 14971
Risk Management
21 CFR Part 820 / QMSR
Quality Management System Regulation
ISO 13485
Quality Management
IEC 60601-1
Basic Safety and Essential Performance
Design History File (DHF)
and Design Input/Output Documentation
Wireless Certifications
FCC Part 15
for BLE and Wi-Fi
Bluetooth SIG Qualification (QDID)
IEC 60601-1-2 EMC
for Wireless Medical Devices
CE, UKCA, and TGA
International Certifications
IEEE C63.27
Wireless Coexistence
Data Privacy & Security
These frameworks govern patient data at the organization level. We engineer the device and system architecture to support them.
HIPAA
Patient Data Privacy
HITRUST and SOC 2
Compliance Frameworks
NIST Cybersecurity Framework
for Healthcare Applications

Clinical Domains

We've Built Therapeutic Systems Across the Clinical Landscape.

That landscape spans implantable and body-worn devices, and the clinic and home workflows around them. Every domain below is grounded in delivered programs.

Neurology Icon
Neurology

Implantable Neurostimulators

Peripheral nerve stimulation, brain-computer interfaces, and related neuromodulation platforms.
Audiology Icon
Audiology

Implantable & Worn Hearing Devices

Cochlear implants, fully implanted hearing systems, and externally worn hearing aids.
Cardiology Icon
Cardiology

Cardiac Implantables & Defibrillators

External and wearable defibrillation systems, and the connectivity layers around implanted cardiac devices.
Endocrinology Icon
Endocrinology

Drug Delivery Devices

Insulin delivery systems and connected medication platforms for chronic conditions.
Pulmonology Icon
Pulmonology

Respiratory Therapy Devices

Sleep apnea therapy, chest wall oscillation, and airway clearance platforms.
Orthopedics Icon
Orthopedics

Bone & Spinal Therapy Devices

Bone growth stimulation systems and spinal therapy platforms.
Urology Icon
Urology

Implantable Bladder & Pelvic Therapy Devices

Neurostimulation systems for underactive bladder, incontinence, and related pelvic therapy applications.
Program Highlights

Therapeutic Programs We've Been Trusted With.

We’re drawn to the hard problems, and these are a few of the complex connected therapies we’ve helped build.

Programs •
5

Envoy built the first FDA-approved hearing device that lives entirely inside the body.

The Acclaim™ Cochlear Implant is designed for severe hearing loss, with a sensor that uses the ear’s own anatomy to capture sound in place of an external microphone.

There is nothing to take off before sleeping or showering. There is also nothing easy to power, charge, or connect, and the parts other implants keep outside the head are sealed inside, out of reach without surgery.

Connected Medical Implant
Audiology
Neuromodulation
Clinical Trials
FDA Class III
FDA Pivotal Study
IEC 62304 Class C
Embedded Software
BLE
Charge Management
Embedded GUI
FDA Premarket Cybersecurity
HIL Testing
Inductive Telemetry
Wireless Power Transfer
Diagram of the ear highlighting the cochlea alongside Envoy Medical’s Acclaim fully implanted cochlear device, designed for hearing restoration in the inner ear.

Inspire® is the first FDA-approved neurostimulation therapy for moderate to severe obstructive sleep apnea.

A small implant stimulates the nerve that controls the tongue in time with the patient’s breathing, and a connected system sits around it, with a Bluetooth remote the patient holds, an app, and a clinician web portal that monitors the implant wirelessly.

For someone who could never live with a mask, that means sleeping with nothing on their face and starting therapy with a click. It also means the system around a Class III implant has moved through several device generations while every implant already placed stays in a body for years, so no part of the system can change without accounting for every implant in the field.

Connected Medical Implant
Pulmonology
Neuromodulation
Post-Market
FDA Class III
FDA PMA Approved
IEC 60601
IEC 62304
Design
Electronics
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Azure
Backend API
BLE
Clinician Portal
Connectivity SDK
Cross-Platform
Inductive Telemetry
Infrastructure as Code
Legacy Device Support
Mobile Device Management
Patient using the Inspire Sleep Apnea Therapy System, with implantable device, handheld remote, and mobile app display for tracking therapy and sleep duration.

Portal Diabetes holds FDA Breakthrough Device designation for the Portal Pump™, an implantable insulin delivery system.

The pump is designed to sit in the abdomen, dose from a continuous glucose monitor with a heat-stable concentrated insulin, and take refills in a clinic after weeks or months.

For someone with type 1 diabetes, that means no carbohydrate counting, no meal announcements, and no waking in the night. It also means a loop that closes with no one in it, which has to be trusted before it is ever implanted and then stays in for five to seven years.

Connected Medical Implant
Endocrinology
Drug Delivery
In Development
FDA Class III
HIPAA
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Backend API
BLE
Device Simulators
Mobile Device Management
Native Android
Secure Authentication
Third-Party Cloud Integration
Case Study Hero Portal Diabetes

A stealth-stage medical startup is developing an implanted neuromodulation therapy that its clinicians can adjust without the patient in the room.

For the patient, that means a therapy that changes when it needs to instead of at the next appointment.

It also means every adjustment travels from a clinician’s screen to a device inside someone’s body, and that path has to be trusted at Class III stakes before anything is implanted.

Connected Medical Implant
Neurology
Neuromodulation
Proof of Concept
FDA Class III
IEC 62304 Class C
Design
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Backend API
Biosensing
BLE
Clinician Portal
Embedded Algorithms
FDA Premarket Cybersecurity
Human Factors
Interactive Prototyping
Native Android
Remote Follow-Up
Client Grey Stealth Startup

Synchron ran the first FDA-approved clinical trial of a permanently implanted brain-computer interface, and all six patients met the primary safety endpoint.

The Stentrode® is placed through a blood vessel, with no open brain surgery, and sits in a vein beside the motor cortex reading the intent to move.

For someone with severe paralysis, that means texting, browsing, and opening apps by thought alone. It also means the connection out of the body is the whole product, at Class III stakes. Nothing the implant does reaches a screen unless that link holds.

Connected Medical Implant
Neurology
Brain-Computer Interface
Clinical Trials
FDA Class III
FDA IDE Approved
IEC 62304 Class C
Embedded Software
Security
Systems
Automated V&V
BLE
BLE Optimization
Embedded Linux
FDA Premarket Cybersecurity
HIL Testing
Protocol Interoperability
Threat Modeling
Illustration of Synchron’s brain-computer interface system, showing a neurotech implant connected from the brain to a chest-worn device, with a zoomed-in view of the brain-embedded stent-electrode array.
Programs •
5
Envoy Medical
Diagram of the ear highlighting the cochlea alongside Envoy Medical’s Acclaim fully implanted cochlear device, designed for hearing restoration in the inner ear.

The World's First Completely Internal Cochlear Implant

Envoy built the first FDA-approved hearing device that lives entirely inside the body.

The Acclaim™ Cochlear Implant is designed for severe hearing loss, with a sensor that uses the ear’s own anatomy to capture sound in place of an external microphone.

There is nothing to take off before sleeping or showering. There is also nothing easy to power, charge, or connect, and the parts other implants keep outside the head are sealed inside, out of reach without surgery.

Connected Medical Implant
Audiology
Neuromodulation
Clinical Trials
FDA Class III
FDA Pivotal Study
IEC 62304 Class C
Embedded Software
BLE
Charge Management
Embedded GUI
FDA Premarket Cybersecurity
HIL Testing
Inductive Telemetry
Wireless Power Transfer
Inspire Medical
Patient using the Inspire Sleep Apnea Therapy System, with implantable device, handheld remote, and mobile app display for tracking therapy and sleep duration.

Sleep Apnea Therapy, Connected From Body to Cloud

Inspire® is the first FDA-approved neurostimulation therapy for moderate to severe obstructive sleep apnea.

A small implant stimulates the nerve that controls the tongue in time with the patient’s breathing, and a connected system sits around it, with a Bluetooth remote the patient holds, an app, and a clinician web portal that monitors the implant wirelessly.

For someone who could never live with a mask, that means sleeping with nothing on their face and starting therapy with a click. It also means the system around a Class III implant has moved through several device generations while every implant already placed stays in a body for years, so no part of the system can change without accounting for every implant in the field.

Connected Medical Implant
Pulmonology
Neuromodulation
Post-Market
FDA Class III
FDA PMA Approved
IEC 60601
IEC 62304
Design
Electronics
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Azure
Backend API
BLE
Clinician Portal
Connectivity SDK
Cross-Platform
Inductive Telemetry
Infrastructure as Code
Legacy Device Support
Mobile Device Management
Portal Diabetes
Case Study Hero Portal Diabetes

A Connected Care Platform Around an Implanted Insulin Pump

Portal Diabetes holds FDA Breakthrough Device designation for the Portal Pump™, an implantable insulin delivery system.

The pump is designed to sit in the abdomen, dose from a continuous glucose monitor with a heat-stable concentrated insulin, and take refills in a clinic after weeks or months.

For someone with type 1 diabetes, that means no carbohydrate counting, no meal announcements, and no waking in the night. It also means a loop that closes with no one in it, which has to be trusted before it is ever implanted and then stays in for five to seven years.

Connected Medical Implant
Endocrinology
Drug Delivery
In Development
FDA Class III
HIPAA
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Backend API
BLE
Device Simulators
Mobile Device Management
Native Android
Secure Authentication
Third-Party Cloud Integration
Stealth Medical Startup
Client Grey Stealth Startup

An Implanted Therapy Its Clinicians Configure From Anywhere

A stealth-stage medical startup is developing an implanted neuromodulation therapy that its clinicians can adjust without the patient in the room.

For the patient, that means a therapy that changes when it needs to instead of at the next appointment.

It also means every adjustment travels from a clinician’s screen to a device inside someone’s body, and that path has to be trusted at Class III stakes before anything is implanted.

Connected Medical Implant
Neurology
Neuromodulation
Proof of Concept
FDA Class III
IEC 62304 Class C
Design
Embedded Software
Mobile Apps
Security
Systems
Web Apps & Backends
Backend API
Biosensing
BLE
Clinician Portal
Embedded Algorithms
FDA Premarket Cybersecurity
Human Factors
Interactive Prototyping
Native Android
Remote Follow-Up
Synchron
Illustration of Synchron’s brain-computer interface system, showing a neurotech implant connected from the brain to a chest-worn device, with a zoomed-in view of the brain-embedded stent-electrode array.

An Implant That Turns Thought Into Touchscreen Control

Synchron ran the first FDA-approved clinical trial of a permanently implanted brain-computer interface, and all six patients met the primary safety endpoint.

The Stentrode® is placed through a blood vessel, with no open brain surgery, and sits in a vein beside the motor cortex reading the intent to move.

For someone with severe paralysis, that means texting, browsing, and opening apps by thought alone. It also means the connection out of the body is the whole product, at Class III stakes. Nothing the implant does reaches a screen unless that link holds.

Connected Medical Implant
Neurology
Brain-Computer Interface
Clinical Trials
FDA Class III
FDA IDE Approved
IEC 62304 Class C
Embedded Software
Security
Systems
Automated V&V
BLE
BLE Optimization
Embedded Linux
FDA Premarket Cybersecurity
HIL Testing
Protocol Interoperability
Threat Modeling
Would you like to see additional programs?
Device-to-Cloud Capabilities

Connected Medical Systems, Engineered As One.

Punch Through can own every discipline, so each is built for the way the others behave inside one program. Explore our capabilities across the disciplines.

Talk to the Team That's Built Implantables.

Wherever your connected therapeutic program is right now, this is the place to start.
Two people with a speaking bubble above them and one giving the thumbs up.
A calendar with a phone vibrating.
01
Quick Discovery Call
Share what you're building, timelines, and constraints. We'll confirm fit and the next best step.
Two people with a speaking bubble above them and one giving the thumbs up.
02
Team Consultation
We dig deeper into technical challenges, needs, and where we can add the most value.
A rocket ship launching with check boxes next to it.
03
Scope & Kickoff
We align on milestones, documentation, and delivery. Then we get moving and keep you informed.
Start a Conversation
Happy to sign an NDA before we get into specifics. We reply within 1-2 business days.

Contact Us

How can we help?

Share a few details about your project or challenge. We’ll confirm fit and the next best step within a couple of business days. NDA available.

Person fotoJason SheardTina Hanley
An outline of a bird flying with circuits come out of it.
Name