Responsible innovation (RI) has received increased attention from policymakers and academics as a solution to grand challenges and is viewed as the main driver for innovation. The United Nations has suggested 17 Sustainable Development Goals and responsible innovation can be seen as a tool that allows the movement of society towards reducing inequality, coping with environmental challenges and sustaining countries’ economic and societal development. Our knowledge of how businesses act responsibly in solving these challenges is scarce. An inductive analysis of 14 e-health startups in Norway, shows that responsibility is highly prevalent. Entrepreneurs have instant contact with users (patients or healthcare professionals), which increases inclusiveness, anticipation and reflection as the main elements of responsibility. However, firms’ contextual and strategic awareness of responsibility remains low, which means an absence of focused strategies to exercise responsibility. Consequently, entrepreneurial startups are prevented from reaching broader stakeholders and fully reflecting the knowledge obtained. Moreover, RI activities are often bundled with other activities on the “path” to successful commercialization. This paper contributes to and enriches the current RI understanding from a firm perspective and suggests some implications for practitioners as well as policymakers to enhance sustainable development in the healthcare sector.