Consumer Adoption 2020 Whitepaper - Final

Center for
Digital Health
Digital Health Consumer

Adoption Report 2020
How COVID-19 accelerated  
digital health beyond its years
INSIGHTS YOU WILL LEARN IN THIS REPORT
• COVID-19’s impact on consumer adoption of

digital health tools and services
• Which demographic groups were most likely to  

use various modalities of telemedicine in 2020
compared to previous years
• How consumers’ data-sharing preferences  

changed depending on stakeholder and type  
of health data shared
Digital Health Consumer
Adoption Report 2020
AUTHORED BY
JASMINE DESILVA
Research Manager, Rock Health
RACHEL PRENSKY-POMERANZ
Research Fellow, Rock Health
MEGAN ZWEIG
COO, Rock Health
WITH SUPPORT FROM
Clark Seninger, MBA

Natasha Din, MD
Krishna Pundi, MD
Alex Perino, MD
Mintu Turakhia, MD, Director
CENTER FOR DIGITAL HEALTH,
STANFORD UNIVERSITY
Nina Chiu, Research Fellow

Tom Cassels, President
Claire Egan Doyle, Marketing Director
Bill Evans, Managing Director & CEO
ROCK HEALTH
2
TABLE OF CONTENTS
4 EXECUTIVE SUMMARY
8 METHODOLOGY
10 INTRODUCTION
12 THEME #1: How has telemedicine adoption changed?

Telemedicine use before and during the pandemic.
22 THEME #2: Who still hasn’t adopted telemedicine?

Barriers to accessing telemedicine abound more than expected.
24 THEME #3: How are consumers using digital health tracking tools differently during COVID-19?
Unpacking the trends in health tracking and wearable use.
29 THEME #4: How have consumers’ data-sharing preferences changed during the pandemic?  
A look at consumer trust and willingness to share health data.
33 CONCLUSION
34 APPENDIX: DELAYED CARE
35 ENDNOTES
Digital Health Consumer Adoption Report 2020

© 2021 Rock Health and Stanford Center for Digital Health
3
EXECUTIVE SUMMARY
The COVID-19 pandemic and ensuing healthcare delivery

crisis kicked the digital health ecosystem into high gear.
Stay-at-home orders, physical distancing guidelines, and
closures of outpatient healthcare services encouraged
millions of Americans to seek telemedicine care. For the
first time, digital health solutions were not simply an
enhancement, but rather a necessity in healthcare
delivery.
Rock Health and the Stanford Center for Digital Health

together produced this Digital Health Consumer Adoption
report to understand how consumer behavior in 2020
compared to the five prior years of data that we have
collected. With so much in flux, this year’s analysis puts a
particular lens on how adoption of different digital health
tools differed based on consumer demographics during
the early stages of the pandemic.
During the five years leading up to 2020, adoption of

digital health steadily climbed. The pandemic accelerated
adoption even further and the climb continued. However,
the rate of change in adoption differed by technology and
by subgroup. Telemedicine adoption, for example,
increased most among subgroups which were (in prior
years) already relatively “high” adopters—younger,
higher-income, and more highly educated.
Though not a universal finding, some of the 2020 data

suggest that the pandemic acted more to reinforce and
accelerate underlying trends rather than to draw in new
consumer subgroups as digital health users. The
implications of these nuanced findings are crucial for
startup entrepreneurs, consumers, clinicians, corporate
leaders, and policy makers alike, as the industry continues
to innovate and iterate through the ongoing pandemic.

4
EXECUTIVE SUMMARY
The pandemic that ensued in 2020 makes the timing of this year’s survey particularly relevant. These data were
collected between September 4, 2020 and October 2, 2020, seven months after COVID-19 was declared a national
emergency on March 13, 2020. This survey is a snapshot in time that reflects consumer behavior during a period of
rapid change. Therefore, unlike data from prior years, we believe that 2020 is unlikely to represent a point on a linear
trajectory or continuous trend line. Rather, the adoption trend in future periods may follow more of a step response
path in which a period of overshoot is followed by a new, higher equilibrium that is below the initial “impulse”
delivered by COVID-19. Nonetheless, it is an indicator of the reach of digital health during a time of exceptional
healthcare and societal strain.
Alongside our analysis of the 2020 survey data, we believe that the regulatory environment and ongoing pandemic
response will support an equilibrium of digital health adoption that is lower than the peak observed once the
pandemic first hit, but higher than pre-pandemic levels. The possibility of sustained regulatory reform, in particular,
supports a higher post-pandemic equilibrium level. In early 2020, CMS’s Emergency Declaration Waivers provided
financial incentives that rapidly catalyzed the use of telemedicine. Figure 1 shows that telehealth visits made up 14%
of baseline total outpatient visits at peak adoption in mid-April 2020. The percentage of telehealth visits leveled off
around 6-7% as of October 2020, but remained substantially greater than the pre-pandemic level of 0.1%. Our
survey data suggest that the level of consumer satisfaction with telehealth in particular will make it an attractive
alternative for some demographic subgroups even after in-person care once again becomes a safe option. In the
near term, a second round of stay-at-home orders, a sluggish vaccine rollout, and fears about traditional healthcare
sites are likely to further reinforce use of telemedicine and a range of other digital health tools.
FIGURE 1 1
OUTPATIENT HEALTHCARE UTILIZATION Center for

Digital Health
February 16, 2020 – October 4, 2020
20%
14% 14%
12% 14% 13% 12%
11% 10%
10%
10% 9% 8% 8% 7% 7% 8% 8% 8% 7% 7%
7% 7% 7% 7% 7% 7% 7% 6% 6%
6%
0% 0% 0% 0% 1%
0%
-10%
-20%
-30%
-40%
LEGEND
-50% Telemedicine visits as % of total baseline visits
All types of visits as % change in visits from baseline
-60% In-person visits only as % change in visits from baseline
-70%
02/16 03/08 03/29 04/19 05/10 05/31 06/21 07/12 08/02 08/23 09/13 10/04
Note: Data are presented as a percentage change in the number of visits in a given week from the baseline week (March 1–7).
Source: Ateev Mehrotra et al., “The Impact of the COVID-19 Pandemic on Outpatient Care: Visits Return to Prepandemic Levels, but Not for All Providers and Patients,"
(Commonwealth Fund, Oct. 2020).

5
EXECUTIVE SUMMARY
This white paper explores the four questions outlined below.
Theme #1: How has telemedicine adoption changed? Telemedicine use before and during the pandemic.
Theme #2: Who still hasn’t adopted telemedicine? Barriers to accessing telemedicine abound more than expected.
Theme #3: How are consumers using digital health tracking tools differently during COVID-19? Unpacking the
trends in health tracking and wearable use.
Theme #4: How have consumers’ data-sharing preferences changed during the pandemic? A look at consumer trust
and willingness to share health data.
Here are our key findings:
1. How has telemedicine adoption changed? Telemedicine use before and during the pandemic.
• More consumers used live video telemedicine than ever before. After leveling off between 2018 and 2019,
adoption of live video care increased 11% (from 32% to 43%) in 2020, indicating the significant and swift shift
to live video.
• Telemedicine is not reaching new demographic populations in large numbers (yet). The most likely users
of telemedicine in 2020 remained consistent with past years: higher-income earners, middle-aged adults
(aged 35-54), highly educated, and those with chronic conditions.
• People are highly satisfied with telemedicine—but this may just be relief to have an avenue of care
during the pandemic. Satisfaction with live video visits was higher than in previous years, but may have been
bolstered by the lack of a viable (or safe) alternative for an in-person visit.
• Use of non-video forms of telemedicine is down. Alongside the massive increase in reported live video use,
fewer consumers reported using other forms of telemedicine (e.g., live phone visits, text messaging, and
email) than in past years. A driving factor in the year-over-year reduction in non-video telemedicine may be
the reduction in healthcare utilization across-the-board. That is, consumers used substantially less healthcare
overall (both in person and via telemedicine), lowering the number of consumers who reported using
telemedicine in our survey.
• The future of tech-enabled care models may not be reflected in how consumers are currently using
telemedicine. During 2020, the most common reason for accessing telemedicine was a medical emergency,
and the most common channel was through a patient’s own doctor/clinician. We see these as COVID-19-
necessitated behaviors, but they are not the contours of how we envision telemedicine best serving patients
in the future when tech-enabled care models are proactive, continuous, and outcomes-oriented.
2. Who still hasn’t adopted telemedicine? Barriers to accessing telemedicine abound more than expected.
• Those not using telemedicine prefer in-person care. While a majority of respondents (70%) used at least
one channel of telemedicine (i.e., live video, live phone, text, email, app, pic or video message), 30% of
respondents reported not accessing any form of telemedicine. Most of this group reported their preference is
still to discuss health in person. Still, this represents a large untapped consumer market with opportunities for
startups, investors, and healthcare enterprises to further explore how to meet this population’s needs,
particularly in the context of hybrid care models that integrate ongoing tech-based support with the in-person
care people know and trust—and with the potential for very favorably improving healthcare engagement and
clinical outcomes.
• There is still no good data as to whether this delay in care affected health outcomes. Though out of the
scope of this survey, we are eager to see research on the short- and long-term health impacts of the
underutilization of care in 2020.

6
EXECUTIVE SUMMARY
Key findings continued:
3. How are consumers using digital health tracking tools differently during COVID-19?  
Unpacking the trends in health tracking and wearable use.
• More consumers reported use of digital trackers and wearables. Wearable ownership and use were both
up in 2020, jumping up 10 percentage points from 33% in 2019 to 43% in 2020, after not growing at all
between 2018 and 2019. Emerging spaces such as women’s health—for fertility and menstrual tracking—may
have contributed to the proliferation of digital tracking: 83% of women who track their fertility and 67% of
those tracking their menstrual cycle used digital methods. The consumer groups most likely to track their
health digitally were under 55 years old, respondents with chronic conditions, higher income earners, and
urban respondents.
• Wearable use is still low in select subgroups. Despite overall wearable ownership soaring, there were
subgroups with lower rates of ownership: rural adults, those making less than $75K annually, adults aged over
55, women, and those without bachelor or graduate degrees. Similar to findings among telemedicine, the
data points to a digital divide that continues to favor adoption among suburban, higher-income, highly
educated adults. At the risk of further exacerbating this divide (and associated health disparities), policy
makers and innovators alike must address barriers to technology and internet access, as well as build solutions
that account for segmented preferences and trust.
4. How have consumers’ data-sharing preferences changed during the pandemic?  

A look at consumer trust and willingness to share health data.
• Consumers (still) do not equally trust everyone with their data. Willingness to share personal healthcare
data remains largely unchanged from previous years. In some instances, consumers are more likely to be
willing to share their COVID-19 results than other personal health information. For example, about double  
the number of respondents were willing to share their COVID-19 results rather than their health data with the
government and their employer.

7
METHODOLOGY
Since 2015, Rock Health has annually surveyed 4,000 US

adults to track consumer adoption of digital health
technologies. As in the past, Rock Health and the
Stanford Center for Digital Health collaborated to analyze
the survey data and produce this Digital Health Consumer
Adoption white paper. In 2020, the sample size was nearly
doubled to allow for deeper subgroup analysis and a
greater ability to examine changes in consumer behavior
in light of the pandemic.
A survey of 7,980 US adults was conducted by Toluna

USA, Inc. between September 4, 2020 and October 2,
2020. Respondents used their personal desktop, laptop,
smartphone, or tablet to complete the survey, which was
in English. Survey respondents were selected from
Toluna’s network of members, who receive “points” that
can be redeemed for rewards such as gift cards for
participating in surveys (Toluna does not disclose the
value of each “point”). Toluna targeted respondents
based on member profiles to obtain a sample
representative of US Census demographics (e.g., gender,
age, geographic region, race, and income). The median
interview duration was 13 minutes. The survey included
q u e s t i o n s a b o u t re s p o n d e n t s ’ h e a l t h p ro f i l e ,
demographics, adoption of digital health tools, sentiment
about digital health technology, and COVID-specific
questions (e.g., seeking and sharing test results, delaying
care, interest in potential vaccines).
As seen in Figure 2, our survey population closely

matched Census demographics. This report relies on
historical comparisons to prior consumer adoption survey
data from 2015 to 2019 using a similar methodology as
the 2020 survey, with some exceptions noted throughout
the white paper to rephrase some questions for clarity
and the addition of COVID-19-related questions. Survey
respondents are referred to as “respondents” or
“consumers” throughout this report.

8
METHODOLOGY
FIGURE 2
SURVEY RESPONDENT DEMOGRAPHICS
2020
SEX AGE
11%
100% Prefer not to disclose 100% 9% 7% 75 and older
49% 51%
Male 12% 13% 65-75 years
55-64 years
75% Female 75% 17% 16% 45-54 years
35-44 years
16% 17% 25-34 years
50% 50% 18-24 years
51% 49% 18%
16%
25% 25% 18% 18%
12% 11%
0% 0%
CENSUS CONSUMER CENSUS CONSUMER
ADOPTION SURVEY ADOPTION SURVEY
INCOME ETHNICITY
0.4% WHITE
100%
16% 16% Prefer not to disclose SURVEY 69%
$150,000 and above
CENSUS 72%
75% 29% 27% $75,000 to $149,999
$35,000 to $74,999 BLACK
Less than $35,000 SURVEY 13%
50% 29% 29% CENSUS 13%
HISPANIC
25% 28% SURVEY 15%
27%
CENSUS 18%
0% ASIAN
CENSUS CONSUMER SURVEY 6%
CENSUS 6%
ADOPTION SURVEY
Source: Rock Health Digital Health Consumer Adoption Survey (n2020 = 7,980). US Census. Note: Question for sex - Survey: “what is your biological sex (ie what sex were
you assigned at birth)?” Responses: Male, Female, Prefer not to disclose. Census: “what is person’s sex?” Responses: Male, Female.
Rock Health and the Stanford Center for Digital Health analyzed this de-identified survey dataset to identify
patterns, trends, and insights in consumer adoption of digital health solutions. For statistical analyses, we used
logistic regression to determine the association between a primary predictor and outcome of interest, controlling for
covariates (i.e., confounders) in multivariate regression analysis. Individuals with missing information on the use of
digital health technology were excluded. Covariates included age, race, biological sex, area, region, insurance type,
income, educational attainment, chronic disease/condition, doctors’ visit in a year, and health status. For all analyses,
p-values were two-sided, with those less than 0.05 considered statistically significant. Statistical analyses were
conducted using STATA version 12.0 (Stata Corp, College Station, Texas).
These survey data have important limitations. The data is cross-sectional and relies on self-reported respondent
data, which is subject to recall bias. Although the sample size is large, we cannot rule out sampling bias. For
example, respondents completed the survey using a desktop, laptop, smartphone, or tablet, spoke English, and
were willing to complete a moderate-length survey. As a result, 93% of survey respondents answered that they own
a smartphone, compared to 81% of all Americans. In addition, 96% of respondents answered that they had reliable
internet access, compared to 90% of all Americans who use the internet. Those willing to participate could be more
engaged in their healthcare or digital technology compared to those who declined. We did not survey the same
participants year after year, so trends reflect shifts in the population rather than in specific individuals.
9
INTRODUCTION
Digital health use in 2020 was a reflection of consumers’

responses to the coronavirus pandemic:
• The quick pivot by providers to offer remote care

yielded a significant uptick in use of live video
telemedicine, with 43% of respondents reporting that
they had a video visit (compared to 32% in 2019).
• Wearable use was up in 2020, with 43% of all

respondents reporting that they owned a wearable  
(up from 33% in 2019). Chronic condition management
could be driving this uptick, with many (66%) of those
who started using a wearable for the first time during
COVID-19 using it to manage a diagnosed health
condition, and 51% of all wearable owners using their
wearable to manage a diagnosed health condition  
(up from 28% of wearable owners in 2019).
• Over half of respondents tracked a health metric  

(e.g., weight, heart rate, blood pressure) using a digital
tracker, up 12 percentage points from 2019.
• Sixty percent of respondents searched for provider

reviews online, which is a slightly smaller percentage
than in 2019 and may reflect the overall reduction in
healthcare utilization brought about by the pandemic.
• The majority of respondents continue to search online

for health information—on symptoms, treatments,
medications—though a slightly smaller percentage of
respondents reported doing so (67% in 2020 versus
73% in 2019).

10
INTRODUCTION
FIGURE 3 2
ADOPTION OF DIGITAL HEALTH TOOLS Center for
Digital Health
2015–2020
100%
LEGEND
75% 2015 2016 2017 2018 2019 2020 76% 77%
73%
69% 70%
67%
64% 64%
61%
58%
54%
50% 50% 51%
43% 43% 42%

38%
34% 33% 33% 33%
32% 31%
25%
24% 24%
22%
19% 18%
13%
7%
0%
LIVE VIDEO WEARABLE DIGITAL HEALTH ONLINE ONLINE HEALTH
TELEMEDICINE 1 OWNERSHIP 2 TRACKING 3 PROVIDER INFORMATION 5
REVIEWS 4
Overall, digital health solutions played a crucial role in enabling care at a distance in 2020. Necessity was the mother
of adoption, particularly around telemedicine and remote health tracking. However, while more consumers used
wearables to track health metrics, it is unclear how well healthcare systems have adapted to this shift in consumer
interest in tracking health data, and it is unknown how much patient-generated data is being integrated into
healthcare and disease management. While uncertainty remains regarding the long-term impact on adoption, the
heightened use of and visibility of digital health solutions offers an opportunity for innovators to prove to consumers
that technology can be an enabler throughout their wellness and healthcare journeys.
What follows is an analysis of four key themes emerging in 2020.
[1] Survey question 2015-2019: When, if ever, have you received medical care or advice from a healthcare professional (e.g., doctor, nurse, therapist) through the following
means: Live video call on a mobile phone, tablet, or computer (not YouTube or other educational/information web videos)? Responses: In the last 12 months, More than 12
months ago; Survey question 2020: Have you received medical care or advice from a doctor or other clinician through the following types of virtual care (i.e., live video)?
Response: Yes.
[2] Survey question 2015-2020: Do you own a wearable device or smart watch (note: this excludes smartphones) that helps you track your health? This could include number of
steps/exercise, sleep, heart rate, or blood pressure. Response: Yes.
[3] Survey question 2015-2020: How do you currently record the following: Weight, Heart rate, Blood pressure, Medications, Physical activity (steps, exercise, etc.), Food/diet,
Sleep, Blood sugar, Other?
Responses: With a wearable, Connected device (e.g., smart scale, glucometer) or in an app that doesn’t connect to a wearable, In a digital journal or log.
[4] Survey question 2015-2020: Have you used a mobile app or website to find any of the following?
Responses: A specific physician or nurse practitioner, An in-home caregiver including private duty nurses, A hospital or clinic, A pharmacy, A nursing home or long-term care
facility, A physical therapist, A psychologist, therapist or counselor, An integrative and or lifestyle medicine practitioner.
[5] Survey question 2015-2019: When, if ever, have you searched for any of the following using a website or mobile app: Information about prescription drugs and/or side
effects, A diagnosis based on your symptoms, Treatment options based on your diagnosis? Responses: In the last 12 months, More than 12 months ago; Survey question 2020:
Have you searched for any of the following using a website or mobile app: Information about prescription drugs and/or side effects, A diagnosis based on your symptoms,
Treatment options based on your diagnosis? Response: Yes.
Source: Rock Health Digital Health Consumer Adoption Survey (n2020 = 7,980; n2019 = 4,000; n2018 = 4,000; n2017 = 3,997; n2016 = 4,015; n2015 = 4,017).

11
THEME #1
How has telemedicine adoption changed?

Telemedicine use before and during the pandemic
ADOPTION OF LIVE VIDEO VISITS JUMPED IN 2020, WHILE OTHER TELEMEDICINE USE TAPERED
Live video telemedicine visits hit a high water mark in 2020, with 43% adoption among respondents, an 11
percentage point increase from 2019. Simultaneously, use of non-video telemedicine channels (e.g., live phone, text
messaging, email) was down from 2019. The data on telemedicine adoption in 2020 points in two different
directions: up for live video, down for everything else.
FIGURE 4
TELEMEDICINE ADOPTION BY CHANNEL Center for

Digital Health
2015–2020; up for video, down for everything else
100%
LEGEND
2015 2016 2017 2018 2019 2020
75% Increase from 2019 Decrease from 2019
64%64%
59%58%
50% 50%
53%54%
48% 47%
44% 45% 45%43%
43% 42% 41%
38% 37%
34%
32% 32% 32%
25% 29%29% 27%
24%23% 23%
22%
19%
12%
7%
0%
LIVE VIDEO LIVE PHONE TEXT EMAIL PICTURE OR HEALTH APP/
MESSAGE VIDEO WEBSITE
This finding (i.e., consumer utilization of some forms of telemedicine fell during the early stages of the pandemic) is
initially surprising, particularly in light of widely reported increases of telemedicine utilization among providers. We
propose that a Will Rogers phenomenon led to this outcome. Importantly, overall healthcare utilization declined
dramatically in the early part of 2020: utilization hit a low point in late March with 60% fewer visits3 completed than
during the same period the prior year. The CDC's June 2020 survey results reported an estimated 41% of US adults
delayed or avoided medical care including urgent or emergent care (12%) and routine care (31%). Our data
corroborate this trend: 42% of respondents reported delaying necessary medical care during COVID-19 that they
would have normally sought.4

12
THEME #1
Given that a substantially lower proportion of US adults increased rates of telemedicine utilization among
sought care of any kind in early 2020, we would expect healthcare providers. Because our survey is a sample of
that a lower number of US adults utilized each form of consumers—and not providers—we use a different
care, including care delivered via telemedicine during denominator (i.e., consumers), allowing for both
that same timeframe. Put in context, a decline in observations to be true at the same time. That is, both
utilization of telemedicine broadly is to be expected, in-person and all visits overall dropped in 2020, but in-
and the surprising result in our data is therefore the person visits dropped by a larger percentage than all
dramatic increase in use of live-video telemedicine. visits (see Figure 1, Outpatient Healthcare Utilization),
meaning the percentage of visits that were conducted
We note that this observation (i.e., that fewer via telemedicine rose. At the same time, because a
consumers used telemedicine in mid 2020 than in
substantially smaller number of consumers overall
2019) may appear to contradict widely reported,
sought care, a likewise smaller number of consumers
utilized telemedicine than in prior years.
FIGURE 5
PERCENT CHANGE IN VISITS FROM BASELINE Center for

Digital Health
February 16, 2020 – October 4, 2020
15%
0%
-15%
-30%
LEGEND
-45%
Cumulative change in all visits
(in person and telemedicine)
-60%
02/16 03/08 03/29 04/19 05/10 05/31 06/21 07/12 08/02 08/23 09/13 10/04
Note: Data are presented as a percentage change in the number of visits in a given week from the baseline week (March 1–7).
Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Care: Visits Return to Prepandemic Levels, but Not for All Providers and Patients (Commonwealth Fund, Oct. 2020).
Amidst the decline in overall healthcare utilization, beneficiaries, representing an astounding 2,632%
adoption of live-video telemedicine increased, driven increase compared to the same timeframe in 2019.5
by public health guidance, stay-at-home orders, and According to research from The Commonwealth Fund,
CMS’s relaxed federal restrictions on telemedicine, telehealth visits across all payer types made up 14% of
including out-of-state licensures, reimbursement baseline total outpatient visits at peak adoption in mid-
guidance, and originating site requirements. April. The percentage of telehealth visits leveled off
around 6-7% as of October 4, 2020 (see figure 1) which
The CDC reported a dramatic 154% increase in is still substantially greater than the pre-pandemic
telehealth visits during the last week of March 2020 percentage of 0.1%. All of these sources align with
compared with the same period in 2019. CMS reported
what consumers reported to us about their adoption
another 34.5M telehealth encounters delivered in
behavior in 2020 across segments of telemedicine and
March 2020 through June 2020 for Medicare and CHIP relative to prior years.

13
THEME #1
In addition to point-in-time utilization data, the survey also enabled us to more deeply understand this surge: Who is
adopting telemedicine in 2020 relative to previous adopters? Why are they using telemedicine? Are they satisfied
with the care? All of these analyses offer signals as to where the pendulum will ultimately settle on a more durable
equilibrium.
We examine four components that underpin and drive Theme 1, changes in telemedicine adoption, below:
1. Page 15: Telemedicine user profiles in 2020 versus 2019
2. Page 16: Reasons why telemedicine users sought care in 2020 compared to 2019
3. Page 17: Channels used to access telemedicine care
4. Pages 18-20: Evaluating consumer satisfaction for telemedicine compared to in-person care
At the end of Theme 1, we offer Rock Health’s perspective on what we think is to come—our “prescription” for the
future of telemedicine.

14
THEME #1
COMPONENT #1: Telemedicine user profiles in 2020 versus 2019
TELEMEDICINE USE IS CONCENTRATED AMONG YOUNGER , HIGHER - INCOME , AND HIGHLY EDUCATED
CONSUMERS , AS WELL AS THOSE LIVING WITH A CHRONIC CONDITION
Overall, the data shows that despite the fluctuations in telemedicine use, there are few significant differences
between telemedicine users in 2020 and telemedicine users in 2019.6
• Health status and utilization are linked to telemedicine utilization. Seventy-eight percent of respondents with
at least one chronic condition were telemedicine users in 2020, compared to 56% of those without a chronic
condition.7 Furthermore, 87% of high healthcare utilizers (6+ doctor visits in a year) were telemedicine users,
compared to 77% of moderate utilizers (2-5 visits in a year) and 55% of low utilizers (0-1 doctor visits in a year). In
addition, 82% of respondents with four or more prescriptions used telemedicine, compared to 76% of those with
1-3 prescriptions and 50% of those with no prescriptions.8 
• 35- to 54-year-olds are the most likely adopters of telemedicine.9 Seventy-eight percent of respondents aged
35 to 54 were telemedicine users in 2020. 18- to 34-year-olds were the next highest utilizers at 73% in 2020,
which was a drop from being the highest utilizers in 2019 at 80% adoption. Fifty-nine percent of respondents 55
and older used telemedicine. Overall, these numbers didn’t change dramatically from 2019, with the exception
of those 55 and older, which dropped from 71% utilization in 2019 to 59% utilization in 2020. 
• In 2020, men were more likely to use telemedicine than women.10 A higher percentage of men used
telemedicine in 2020 compared to women and nonbinary respondents (74% of men, compared to 66% of
women and 67% of nonbinary respondents). These gender differences are a departure from 2019, in which men
and women used telemedicine at equal rates (77%).  
• As in 2019, higher-income earners were more likely to adopt telemedicine.11 Respondents with incomes of
$150K and greater reported using telemedicine more than any other income group (85% of respondents earning
$150K or more annually used telemedicine). Comparatively, 65% of those with incomes of $35-75K and 63% of
those making less than $35K annually reported telemedicine use. This positive association between telemedicine
use and income existed in 2019 as well.  
• Those with higher education were likeliest to use telemedicine.12 As in 2019, adoption in 2020 was positively
associated with education. In 2020, 86% of respondents with a graduate or professional degree, master’s degree,
or PhD used telemedicine, compared to 69% of those with an associate’s or bachelor’s degree, 63% of those with
some college without a degree, and 59% of high school graduates or those who did not complete high school. 
• Adoption was highest among those living in urban areas.13 Seventy-nine percent of urban respondents
reported having used telemedicine in 2020, compared to 67% of suburban and 60% of rural respondents.  
• Of note, telemedicine use did not vary dramatically across different racial and ethnic groups.14 Given
ongoing health disparities and the disproportionate impact of COVID-19 on communities of color, multiple
studies have examined adoption of telemedicine by race. However, they have yielded different conclusions. One
study found that at the peak of the pandemic in the nation’s hotspot, New York City, Black and Hispanic/Latinx
residents were more likely to have a first encounter via the ER or an office visit than telehealth, compared to
white residents. Another study from JAMIA found that Black people were significantly more likely to report using
telehealth than white people. We hope to see further analysis to assess the accessibility of digital health solutions
to populations disproportionately impacted by COVID-19 and other diseases.

15
THEME #1
COMPONENT #2: Reasons why telemedicine users sought care in 2020

compared to 2019
TELEMEDICINE USERS ACCESSED LIVE VIDEO AND LIVE PHONE VISITS FOR DIFFERENT REASONS IN 2020
As shown in Figure 6, live video telemedicine users reported accessing visits primarily for a medical emergency
(33%) in 2020, followed by minor illness (25%), chronic condition (19%), and mental health condition (15%). An even
higher percentage used live video for a medical emergency (41%) in 2019. Comparatively, live phone users in 2020
reported accessing visits due to a minor illness the most (39%), followed by chronic condition (25%) and medical
emergency (14%).
FIGURE 6
REASON FOR SEEKING TELEMEDICINE Center for

Digital Health
2020
LIVE VIDEO CALL 19% 33% 15% 25% 8%
LIVE PHONE CALL 25% 14% 12% 39% 11%
LEGEND
Chronic condition Medical emergency Mental health condition Minor illness Other
Note: Reflects data from the survey question: “What was your primary reason for seeking this type(s) of virtual care?”
Among live video telemedicine users with at least one chronic condition, the most common reason for seeking care
was for a medical emergency (35% of all live video users), while respondents without a chronic condition mainly
sought video care due to a minor illness (38% of all live video users).

16
THEME #1
COMPONENT #3: Channels used to access telemedicine care
MOST LIVE VIDEO AND PHONE USERS ACCESSED TELEMEDICINE THROUGH THEIR DOCTOR / CLINICIAN
( NOT THEIR EMPLOYER , INSURER , OR OTHER CHANNELS )
There are multiple routes for consumers to engage with telemedicine services, whether through an offering from
their own physician, health plan, employer, or a direct-to-consumer service that they source themselves. Across 2019
and 2020, the most common path for live video and live phone visits was through a patient’s doctor/clinician. The
influence of clinicians grew significantly in 2020, as many providers were, for the first time, compelled to offer
remote care: 70% of live video telemedicine users and 60% of live phone telemedicine users accessed telemedicine
through their doctor in 2020, compared to 50% of live video users and 45% of phone users in 2019. Insurance
companies were a distant second. Just 20% of live phone telemedicine users and 13% of live video telemedicine
users engaged a service through their insurer.
We also observed variation by age group. While all age groups were most likely to access telemedicine through
their doctor/clinician, younger respondents were more likely than older respondents to access telemedicine through
a service offered by their insurance company or an independent service.
FIGURE 7
MODE OF TELEMEDICINE ACCESS Center for

Digital Health
2020
LIVE VIDEO CALL 8% 70% 6% 13% 3%
LIVE PHONE CALL 7% 60% 6% 20% 6%
FIGURE 8
MODE OF TELEMEDICINE ACCESS

2020, by age
18-34 years
LIVE VIDEO
10% 63% 8% 15% 5%

CALL
35-54 years 9% 70% 6% 12% 2%
55 years+ 4% 81% 2% 10% 3%

LIVE PHONE
18-34 years 11% 49% 10% 24% 7%

CALL
35-54 years 6% 52% 8% 29% 5%
55 years+ 4% 81% 1%
6%
6% 8%
1%
LEGEND
A service independent from my doctor/clinician, insurance company, and employer
A service offered by my doctor/clinician A service offered by my insurance company
A service offered by my employer Other
Note: Reflects data from the survey question: “How was this type(s) of virtual care made available to you?”

17
THEME #1
COMPONENT #4: Evaluating consumer satisfaction for telemedicine

compared to in-person care
CONSUMERS SHOWED HIGHEST SATISFACTION FOR LIVE VIDEO CALLS , WITH A NINE PERCENTAGE POINT
INCREASE IN “ EXTREME SATISFACTION ” COMPARED TO 2019
In 2020, consumers who used any modality of telemedicine were overwhelmingly satisfied with their experience, and
the percentage of respondents extremely or moderately satisfied with their visit was up from 2019 across-the-board.
Ninety percent of live video and 86% of live phone users were extremely or moderately satisfied with their visit.  
Just 4% of live video and phone telemedicine users were dissatisfied.
FIGURE 9
OVERALL SATISFACTION BY MODE OF TELEMEDICINE Center for

Digital Health
2019–2020
2020 5% 16% 33% 47%

TEXT MESSAGE
2019 7% 22% 33% 39%
2020 4% 16% 31% 49%

EMAIL
2019 7% 20% 30% 44%
2020 4% 12% 39% 45%

PICTURE OR VIDEO
2019 6% 22% 30% 42%
2020 4% 11% 33% 52%

HEALTH APP/WEBSITE
2019 6% 15% 34% 45%
2020 4% 10% 36% 50%

LIVE PHONE CALL
2019 5% 15% 37% 43%
2020 4% 7% 25% 64%

LIVE VIDEO CALL 6% 16% 23% 55%
2019
Extremely or moderately dissatisfied Neither satisfied nor dissatisfied

LEGEND
Moderately satisfied Extremely satisfied
Note: Reflects data from the survey question: “How satisfied or dissatisfied were you with this type(s) of virtual care?”

18
Component 4 continued THEME #1
CONSUMERS REPORTED A PREFERENCE FOR TELEMEDICINE CARE OVER IN - PERSON CARE IN 2020
The survey also asked telemedicine users how their telemedicine visit experience compared to previous in-person
care visits.
As shown in Figure 10, across nearly all telemedicine modalities—with the exception of phone visits—consumers
were most likely to be more satisfied with their virtual interaction. Satisfaction was highest for live video visits,
followed by text message and picture or video. Still, 19-34% of respondents were less satisfied with their virtual
interaction compared to a previous in-person interaction, depending on the modality.
FIGURE 10
SATISFACTION COMPARED TO PAST IN-PERSON Center for

Digital Health
INTERACTION BY MODE OF TELEMEDICINE
2020
TEXT MESSAGE 34% 25% 41%
EMAIL 31% 31% 38%
PICTURE OR VIDEO 40% 19% 41%
HEALTH APP/WEBSITE 29% 31% 40%
LIVE PHONE CALL 35% 35% 30%
LIVE VIDEO CALL 22% 25% 53%
LEGEND
I was less satisfied with my virtual interaction(s) than past in-person interactions.
I was equally as satisfied with my virtual interaction(s) as with past in-person interactions.
I was more satisfied with my virtual interaction(s) than past in-person interactions.
Note: Reflects data from the survey question: “How did this type(s) of virtual care compare to your past in-person care experiences?”

19
Component 4 continued THEME #1
Subgroup analysis revealed some differences in These data also suggest multiple interpretations for
telemedicine satisfaction. In multivariate regression innovators to consider. For instance, high satisfaction
analysis, young and middle-aged adults had higher levels in 2020 may be a function of the circumstances
odds of being satisfied with both video and phone created by the pandemic. If a person in need of care
telemedicine visits (each age group up to 55 had cannot access in-person care—due to office closures or
higher odds of satisfaction for video visits, and each fear of contracting COVID-19—then it follows that the
age group up to 75 had higher odds of satisfaction for virtual alternative would be preferable to no care.
phone visits).15 Living in an urban area was associated Under this interpretation, satisfaction could be a
with higher satisfaction for video visits, but not phone barometer of relief, rather than preference. This
visits.16 The odds of being satisfied with both video interpretation would suggest that satisfaction will fall
and phone visits increased significantly with income.17 once consumers are able to return to in person visits
While a higher percentage of men reported being and feel comfortable doing so.
satisfied with both live video and phone visits,
regression analysis did not reveal any statistical On the other hand, high satisfaction in 2020 may
association between gender and satisfaction. presage a fundamental shift in consumer preference to
virtual care models. Perhaps consumers value elements
Finally, a higher percentage of white respondents were of virtual care—accessibility, efficiency, affordability—
more satisfied with their live video visit than non-white above and beyond their in-person experience. This
respondents, but a higher percentage of non-white interpretation suggests that the higher levels of live
respondents were more satisfied with their phone visit video telemedicine adoption in 2020 could translate
than white respondents. White ethnicity was associated into sustained and perhaps even increased use over
with higher satisfaction for video and phone visits as time, as satisfied adopters share their experiences with
compared to non-whites in univariate analysis, but family and friends.
these associations were no longer significant in
covariate adjusted analysis.18 However, given the well- Our best guess is that both of these factors are at play.
documented differences in how people of color access, Consumers adjusted to virtual visits when it was
experience, and receive healthcare as compared to necessary—but they then shifted partly back to in-
white respondents, it will be important to further person care when it became widely available again. As
explore and address variations or biases embedded in such, consumers demonstrated they still prefer in-
telehealth care delivery. person care to telemedicine, even if they report being
satisfied with the latter. However, we do think that new
We hope these differences in subgroup satisfaction telemedicine users—patients and providers alike—
motivate entrepreneurs and intrapreneurs to closely likely had some transformative experiences that will
examine how they are building products. Our data influence future behavior. If government and
suggest several questions innovators can consider that commercial reimbursement of telemedicine continues
are likely to drive satisfaction (and, therefore, the to make virtual visits accessible and affordable, we
successful adoption of telemedical services): Who are anticipate some patients and providers will see it as a
we building for? Why might certain groups feel less preferable alternative to some types of in-person visits.
engaged with telemedicine, or particular channels of
telemedicine? Are we offering context-specific and
culturally competent care to specific populations?

20
THEME #1
Prescriptions for the future: A look ahead for telemedicine
During 2020, more consumers used live video telemedicine than ever before. The most common reason was for a
medical emergency, and the most common channel was through a patient’s own doctor/clinician. COVID-19
necessitated these changes in consumer behavior. But in observing market shifts beyond just the survey data set  
(a lagging indicator of innovation), we at Rock Health and Stanford’s Center for Digital Health foresee shifts in how
telemedicine will serve consumers in the future:
• Telemedicine must shift from a transactional model to a continuous virtual care model. The bulk of
telemedicine adoption in 2020 resembled the traditional synchronous, reactive, and episodic patient-provider
care model. New innovations offer the possibility of “full-stack” services that are proactive, continuous, and
better positioned to match limited provider supply to demand. We speculate that the adoption of
transactional care tools in 2020 will create a more receptive market for full-stack healthcare and believe a
move in this direction will yield a better patient and provider virtual care experience.
• Telemedicine needs to seek a different kind of customer. Admittedly, it is alarming that a third of video
visits were for a medical emergency. At-home care has limitations, among them dealing with many types of
medical emergencies. Given satisfaction rates, it is clear that video telemedicine played a critical stop-gap
measure for consumers with a medical emergency, and respondents seeking video care for medical
emergencies were more satisfied with their care than video users overall. Ninety-six percent of those who
sought video telemedicine for medical emergencies were moderately or extremely satisfied with their care,
and 83% were more satisfied with their video visit than with their past in-person care, both metrics exceeding
satisfaction for video visits overall (90% moderately or extremely satisfied with their care and 53% more
satisfied than with past in-person care). But, particularly as health plans and retail organizations become
increasingly sophisticated in their virtual care offerings, it’s important to build for the type of utilization that  
is appropriate and financially sustainable—which likely means building for chronic conditions and lower  
acuity care.
• New care models are disintermediating the patient-provider relationship. Although most telemedicine
visits in 2020 were with one’s existing doctor/clinician, other models are emerging. As providers invest in
virtual offerings that support current care models, they are increasingly competing against direct-to-consumer
and other digital health startups, retail offerings, and employer- and health plan–funded telemedicine
options. The opportunity for consumers to access care outside of their existing provider relationships is
growing. Many consumers will prefer their existing physician, but our 2020 data reinforced the degree to
which younger consumers are more likely than their older counterparts to access telemedicine outside of
their provider: The next generation of healthcare consumers is rapidly going digital.

21
THEME #2
Who still hasn’t adopted telemedicine? Barriers to

accessing telemedicine care abound more than expected
A THIRD OF CONSUMERS DID NOT USE TELEMEDICINE IN 2020
Despite unprecedented increases in live video telemedicine use in 2020, 30% of respondents reported not using  
any form of telemedicine, compared to 23% in 2019. As seen in Figure 11, 52% of respondents who did not access
telemedicine said it was due to a preference to discuss health in person. Fewer of these respondents in 2020
reported not being aware of telemedicine options compared to 2019 (22% versus 34%), perhaps a function of
messaging from public health officials, healthcare providers, and payers. Data also showed that a third of providers
were still not offering telemedicine as of September 2020, which causes a significant barrier to access for patients.
FIGURE 11
REASONS WHY RESPONDENTS DID NOT ACCESS TELEMEDICINE Center for

Digital Health
2019–2020
100%
LEGEND
2019 2020
75%
50%
52%
50%
25%
34%
22%
20% 19%
11% 11%
4% 3%
0%
PREFER TO DISCUSS NOT AWARE PROVIDER DID COST POOR CELL
HEALTH IN PERSON OF OPTIONS NOT OR
RECOMMEND BROADBAND
Note: Numbers do not add up to 100% as respondents could choose multiple responses. Reflects data from the survey question: “What is your reason for never
accessing virtual care from a healthcare professional?”

22
THEME #2
Telemedicine non-users tended to be:
• Women: In 2020, more women reported not accessing telemedicine compared to men (34% and 26%
respectively). This difference is new—in 2019, there were no meaningful differences across gender.19
• Older: In regression analysis, older respondents were significantly less likely to use telemedicine. In 2020,
41% of 55 and older respondents reported never using telemedicine (29% in 2019), compared to 22% of 35-
to 54-year-olds (also 22% in 2019) and 27% of consumers aged 18-34 (20% in 2019).20
• Lower income: Lower-income respondents were more likely to report not using telemedicine in both 2019
and 2020, compared to higher-income earners.21
• Rural: The odds of not using telemedicine is highest among rural respondents, compared to suburban and
urban respondents. Forty percent of all rural respondents reported not using telemedicine in 2020 (29% in
2019), compared to 33% of suburban respondents (24% in 2019), and 21% of urban respondents (20% in
2019).22
• No prescriptions: Those who reported having no prescriptions were most likely not to use telemedicine
(50%) versus respondents on 1-3 prescriptions (24%) and respondents taking four or more medications (18%).
23
• Hispanic respondents: The odds of not using telemedicine was highest for Hispanics in both univariate and
multivariate regression analysis.24
Despite increased flexibilities around telemedicine, including eliminated cost-sharing in many cases, there is still a
sizable untapped market for digital health adoption. Subgroup analyses reveal important insight on why some of the
groups outlined above are currently non-users, and hints directionally at how innovators may better design for them:
• Older respondents were more likely to not access care due to a preference for in-person care, while cost for
this group was less important. Comparatively, younger respondents (aged 18-34) reported that their top
reason for not using telemedicine was not being aware of options.
• A higher percentage of white respondents did not seek telemedicine because they prefer to discuss health in
person, while a higher percentage of non-white respondents were not aware of telemedicine options.

23
THEME #3
How are consumers using digital health tracking tools

diﬀerently during COVID-19? Unpacking the trends in
digital health tracking and wearable use
DIGITAL HEALTH TRACKING CLIMBED IN 2020, ESPECIALLY AMONG THOSE WITH CHRONIC CONDITIONS
More consumers are using digital tools to track their The health metrics tracked (digitally or analog) by the
health data in 2020 than ever before. Eighty-three m o s t re s p o n d e n t s w e re w e i g h t ( 5 0 % o f a l l
percent of all respondents tracked their health data in respondents), medications (33%), blood pressure (32%),
any form (digital or analog), up four percentage points food and diet (32%), and physical activity (32%). The
from 2019. And a large majority (65%) of respondents health metrics with the greatest portion of digital
who tracked a health metric in 2020 used digital tools trackers (here we refer to people who track a health
to do so, up 10 percentage points from 2019. metric as “trackers”) were fertility (83% of fertility
trackers are tracking digitally), heart rate (75% of heart
Out of the whole survey population (including non- rate trackers), physical activity (73% of physical activity
trackers), 54% of respondents use a digital method to trackers), and menstrual cycle (67% of menstrual cycle
track a health metric, while 29% strictly use analog trackers). Across demographic groups, the highest
tracking—demonstrating the deepening adoption of reported rates of digital tracking were among those
digital tracking. under 55 years old, those with chronic conditions,
higher-income earners, and urban respondents.
FIGURE 12 25
RESPONDENTS TRACKING AT LEAST ONE HEALTH METRIC Center for

Digital Health
2017-2020, by mode of tracking
100%
LEGEND
Digital tracking Analog tracking
75%
54%
50% 44%
38%
33% 45%
41%
25% 35%
29%
0%
2017 2018 2019 2020

24
THEME #3
Across all health metrics, the chronic condition populations with the highest rates of digital tracking were those with
heart disease, diabetes, and obesity. Among respondents with the chronic conditions outlined in Figure 13, the
health metrics with the highest rate of digital trackers were heart rate, blood sugar, and blood pressure. For each
chronic condition listed in Figure 14, the overall percentage of those tracking specific health metrics (e.g., heart rate,
weight) is up compared to 2019, as is the percentage of trackers using digital methods.
FIGURE 13
TRACKING METHOD BY HEALTH METRIC Center for

Digital Health
2020
FERTILITY 83% 17%
HEART RATE 75% 25%
PHYSICAL ACTIVITY 73% 27%
MENSTRUAL CYCLE 67% 33%
BLOOD SUGAR 64% 36%
SLEEP 61% 39%
OTHER 60% 40%
BLOOD PRESSURE 54% 46%
FOOD DIET 50% 50%
WEIGHT 46% 54%
MEDICATIONS 34% 66%
LEGEND
Digital tracking Analog tracking
Note: Digital tracking defined as in a digital journal or log, with a wearable or connected device (e.g. smart scale, glucometer),
or in an app that doesn’t connect to a wearable. Analog tracking defined as in your head or in a paper journal or log.

25
THEME #3
FIGURE 14
HEALTH TRACKING BY HEALTH CONDITION Center for

Digital Health
2020, percent of respondents tracking by analog and digital methods
HIGH BLOOD
HEALTH OBESITY DIABETES HEART DISEASE COPD PRESSURE
METRICS n=773 n=1,651 n=386 n=334 n=2,238
73% 61% 70%

76% 76%
HEART 12%
7% 6% 9% 8%
RATE 27%
17% 21% 21% 16%
46%
67% 64% 77% 72%
BLOOD 20%
13% 13%
SUGAR 9% 12%
20% 34% 23% 14% 16%
35% 48% 42% 46%

50%
35% 21% 32%

WEIGHT 32% 34%
30% 31% 26% 19% 20%
61% 63% 67% 72% 71%
FOOD OR 14%
19% 17%
DIET 16% 17%
20% 23% 16% 12% 12%
44% 37%
56% 50%
72%
BLOOD 16% 28% 35%
28%
PRESSURE
28% 28% 28% 22% 28%
LEGEND Tracking with digital methods Tracking with analog methods Not tracking
Note: Digital methods defined as in a digital journal or log, with a wearable or connected device (e.g. smart scale, glucometer),
or in an app that doesn’t connect to a wearable. Analog methods defined as in your head or in a paper journal or log.
COPD = chronic obstructive pulmonary disease

26
THEME #3
WEARABLE OWNERSHIP SOARED , BUT USER DEMOGRAPHICS REMAIN LARGELY UNCHANGED FROM 2019
Overall wearable ownership is up 10 percentage points The groups with the lowest rates of wearable ownership
in 2020 compared to 2019, with 43% of consumers are rural, making less than $75K annually, over 55,
owning a wearable in 2020, after a lull in ownership women, without chronic conditions, and those without
growth. The highest rates of wearable ownership were bachelor or graduate degrees.26
reported among the same demographics as those
reporting high rates of tracking (higher income, urban, The majority of respondents reported using wearables to
under 55, with chronic condition), with the addition of become more physically active, track fitness, and lose
men. Men are adopting wearables at a faster rate than weight. Notably, the largest increases in reasons for
women are. In 2019, almost an equal percentage of men wearable use between 2019 and 2020 were for achieving
and women reported owning a wearable (35% of men better sleep and managing a diagnosed condition.
and 32% of women). During COVID-19, 46% of wearable users started using a
wearable for a new purpose. Among those who started
However, in 2020, a gap emerged, with 49% of men (an using a wearable for a new purpose, the most popular
increase of 14 percentage points from 2019) reporting reasons were for managing a diagnosed health condition
owning a wearable, compared to 36% of women (an (66%), fitness training (34%), and becoming more
increase of 4 percentage points from 2019). physically active (32%).27
FIGURE 15
TOP REASONS FOR WEARABLE USE AND WEARABLE UTILITY Center for
Digital Health
2020, by use case
100%
LEGEND
2017 2018 2019 2020
75% 68%
59%
52% 54%
51% 51% 51%
50% 43% 44% 44%44%
40% 40%
37%
31% 30% 28% 30%
27%
24% 24%
25% 20% 18%
21%
0%
FITNESS LOSE SLEEP MANAGE MANAGE BE PHYSICALLY
TRAINING WEIGHT BETTER DIAGNOSED STRESS ACTIVE
CONDITION
% RESPONDENTS REPORTING WEARABLE HELPED ACHIEVE THEIR GOAL:

An answer of 4 or 5 for: “To what degree did the wearable device help you achieve your goal(s)? Please rate on a scale of
1=Not helpful, and 5=Extremely helpful)”
74% 69% 68% 74% 72% 76%

27
THEME #3
DEMOGRAPHIC GROUPS MOST LIKELY TO OWN AND USE WEARABLE CLOSELY FOLLOW TELEMEDICINE
USER GROUPS
On a scale of one to five, respondents were asked to WEARABLES: INTEGRATING HEALTH DATA INTO
rank how helpful their wearable was for achieving each CONSUMERS’ CARE PLANS
of their distinct goals (one being not helpful to five
being extremely helpful). Most respondents reported Wearables and health tracking have become an
their wearable helped them achieve their goals, increasing part of consumers’ connected lifestyles,
especially those using it to become more physically through smart watches, phones, and apps. They offer
active, for fitness training, or to manage a diagnosed opportunities for self-tracking and health management.
condition. Overall, respondents felt similarly about how But on the horizon we see a future in which consumers’
helpful their wearables were in helping them achieve interaction with digital health tools are not one-off, but
their goals as they did in 2019. rather are part of holistic, integrated solutions. As
mentioned above, a continuous, full-stack virtual care
WEARABLE OWNERSHIP SOARED IN 2020, BUT IT model doesn’t just connect patients with providers over
IS TOO SOON TO KNOW IF IT WILL STICK telemedicine; it also integrates remote monitoring to
understand a patient’s progress and proactively flag
Fifty-five percent of respondents who owned a any issues.
wearable in 2020 stopped using it for one or more
purposes (though they may continue using it for We believe that increases in health tracking and
another purpose). 35- to 54-year-olds, men, urban wearable use are paving the way for consumers to
respondents, higher-income individuals, and those with embrace more integrated solutions that are increasingly
chronic conditions stopped using their wearables at being offered by their plans, employers, and providers.
higher percentages, which aligned with 2019 trends as We anticipate that use of tools that we’ve tracked
well.28 However, on average, these same groups were separately in our survey—telemedicine, digital health
using their wearables for more purposes, so that could tracking, wearables, accessing health information
be contributing to the high stoppage rate. Perhaps the online—will become more closely linked as holistic
more ubiquitous nature of wearables carries an solutions offer consumers exposure to all of these
inevitability that some consumers will lose interest or modalities of care and information. For example, a
stop use, but these numbers suggest that innovators consumer who has exposure to telemedicine may also,
have not yet provided ongoing, long-term value from through the same solution, receive a remote
wearables to sustain use and prevent high dropoff monitoring device and have health content delivered to
rates. Yet, it’s a space innovators continue to make big them through an app. Delivering custom, personalized
bets on, with the biggest move coming from Amazon support and care will require a personalization of the
launching its fitness band. toolset, and we’re excited to see a lift in consumers’
exposure to more types of tools.

28
THEME #4
How have consumers’ data-sharing preferences

changed during the pandemic? A look at consumer
trust and willingness to share health data.
THE MOST TRUSTED ENTITIES FOR HEALTH INFORMATION REMAIN UNCHANGED FROM 2019
Our survey asked respondents to rate their trust in health information received from certain entities. Consumer trust
changed little between 2018 and 2019. In 2020, trust crept upward for most entities, with the largest jump for
physicians. In 2020, the most trusted entities remained physicians and friends and family. The demographic
subgroups with the highest overall trust level were also unchanged in 2020 (under 55-year-olds, men, and
respondents who live in urban settings).29
FIGURE 16
TRUST IN SOURCES OF HEALTH INFORMATION Center for

Digital Health
2018–2020, on a scale of 1-5 ,with 5 being “trust completely”
4.37
MY PHYSICIAN 4.29
4.23
3.89
ANY PHYSICIAN 3.58
3.64
3.71
FRIENDS AND FAMILY 3.67
3.72
3.53
HOSPITAL WEBSITE 3.40
3.42
3.39
HEALTH INSURER 3.25
WEBSITE 3.29
3.29
PHARMACY WEBSITE 3.18
3.24
3.00
PHARMA WEBSITE 2.78
2.84
ONLINE HEALTH 2.90

2.87
WEBSITE/APP 3.04
LEGEND
2.08
SOCIAL MEDIA 2.10
2018 2019 2020
2.27
0 1.25 2.5 3.75 5

29
THEME #4
CONSUMER WILLINGNESS TO SHARE DATA DEPENDS ON THE TYPE AND RECIPIENT OF THE DATA
As in previous years, consumer willingness to share their However, respondents revealed some interesting
health data depended on whom they are sharing it with. differences between their willingness to share health  
In 2020, consumers remained most willing to share their data generally versus COVID-19 results. Approximately
health data with their doctor (72%), health insurer (53%), twice the number of consumers were willing to share
and family (52%). their COVID-19 results with the government or their
employer as compared to their willingness to share
In 2020, we also asked respondents specifically about general health data with those same entities.
their willingness to share their COVID-19 test results (if
they were tested or were to get tested). Respondents’ The reverse was true with other entities. For example,
comfort in sharing COVID-19 data followed that of health respondents were more willing to share their general
data generally—consumers were most trusting of their health than their COVID-19 results with pharmacies and
doctor, family, and health insurer. health insurers.
FIGURE 17
WILLINGNESS TO SHARE HEALTH DATA WITH STAKEHOLDER Center for
Digital Health
2019–2020
70%
PHYSICIAN 72%
73%
61%
FAMILY 52%
55%
45%
HEALTH INSURER 53%
52%
35%
PHARMACY 46%
48%
RESEARCH 33%
35%
INSTITUTION 34%
32%
EMPLOYER 15%
LEGEND
HEALTH 25%
25%
TECH COMPANY 23% Willing to share COVID-19 results (2020)
23% Willing to share health data (2020)
GOVT. 12%
ORGANIZATION 12% Willing to share health data (2019)
23%
22%
PHARMA COMPANY 19%
14%
TECH COMPANY 11%
10%
0% 25% 50% 75% 100%

Survey question: “Please indicate which of the following individuals or organizations you would be willing to share your health information with (e.g., your medical records,
test results, prescription drug history, genetic information, and physical activity data) [select all that apply].” “Employer” was not an option as a response in the 2019 survey.
The populations most willing to share their data with physicians were older, higher utilizers (6+ doctor visits in a
year), women, rural, and white.30 There was no consistent trend association with income. When looking at willingness
to share health data with healthcare technology companies, we see a different trend. Younger, higher utilizers, men,
white, and higher-income consumers were more willing to share health data. Older respondents were less willing
than younger consumers to share COVID-19 results with a tech company or a government organization, but more
willing to share with physicians, pharmacies, and insurers.31
30
THEME #4
HEALTH TRACKERS ( REGARDLESS OF TRACKING METHOD ) ARE MORE WILLING TO SHARE THEIR DATA
FIGURE 18
WILLINGNESS TO SHARE HEALTH DATA Center for
Digital Health
2020, by tracking mode
LEGEND
100%
% of analog trackers
84%
% of digital trackers
75% 70% % of non-trackers
67%
61% 61%
52% 53%
50%
50% 45% 43% 45%
40%
38%
35%
27% 28%
24%
25% 23%23%
18% 16% 14% 15% 14%
12% 10% 11%
8% 8% 6%
0%
PHYSICIAN FAMILY HEALTH PHARMACY RESEARCH EMPLOYER HEALTH GOVT PHARMA TECH
INSURER INSTITUTION TECH ORG COMPANY COMPANY
COMPANY
As one may expect, respondents who track (either by analog or digitally) a health metric were more willing to share
data than those that do not (+10%). As illustrated in Figure 18, a higher percentage of analog trackers were willing
to share their health data with family members, insurance companies, pharmacies, physicians, and research
organizations than digital trackers were. However, a higher percentage of digital trackers were willing to share their
health data with tech companies, government organizations, healthcare tech companies, and employers.

31
THEME #4
FEW CONSUMERS ARE WILLING TO SHARE THEIR HEALTH DATA WITH TECH COMPANIES — AMONG THAT
GROUP , TRUST IN SPECIFIC TECH COMPANIES VARIED SIGNIFICANTLY WITH GOOGLE LEADING THE PACK
As noted in Figure 17, 11% of all respondents reported willingness to share their personal healthcare data with tech
companies, a bump after a slight drop from 2018 to 2019. Among those 11% of respondents, we asked which
specific tech companies they were willing to share their data with—these results are outlined in Figure 19.
Willingness to share with certain companies largely rebounded in 2020 from 2019—namely among Amazon, Apple,
and Facebook—but not back to 2018 levels.
FIGURE 19 32
WILLINGNESS TO SHARE HEALTH DATA WITH TECH COMPANIES Center for
Digital Health
2018–2020
Among the respondents willing to share their health data with tech companies, 
those willing to share with specific companies:
100%
11% 10% 11% 57%
89% 90% 89% 56%
60%
75%
52%
45%
50% 53%
45%
47%
25% 51%
45%
0% 42%
49%
2018 2019 2020
39%
LEGEND 42%
46%
Willing to share
38%
Not willing to share
36%
40%
19%
22% LEGEND
2020
14%
16% 2019
2018
Note: The graph to the left reflects data in response to the survey question: “Please indicate which of the following individuals or organizations you would be
willing to share your health information with (e.g., your medical records, test results, prescription drug history, genetic information, and physical activity data)
[select all that apply].”
The graph to the right reflects the following data: for respondents that answered “a technology company” to the question “which of the following individuals or
organizations would you be willing to share your health information with”), they were asked the follow-up question: “Which of the following technology
companies would you be willing to share your health information (e.g., your medical records, test results, prescription drug history, doctor appointment times,
genetic information, and physical activity data) with?” Responses: Amazon, Apple, Facebook, Google, IBM, Lyft, Intel, Microsoft, Samsung, Uber, None of these.
Lyft and Uber were not included in the 2018 survey response options.

32
CONCLUSION
Since we began surveying consumers on their digital health

adoption in 2015, we have seen a steady uptick in use of
telemedicine, wearable ownership and use, online health
information, and digital health tracking. In 2020, spurred by
COVID-19 taxing the healthcare system, we saw a historical
surge in live video telemedicine use amidst the backdrop of an
overall reduction in healthcare utilization. The 2020 survey data
suggest that consumers more than ever expect technology to
be part of their healthcare experience. And, our data show that
a significant proportion of consumers currently prefer virtual
care to in-person visits and noted very high levels of satisfaction
for live video visits in particular. High levels of satisfaction
coupled with greater exposure among providers and patients to
telemedicine and digital health tracking offer promise for next-
generation forms of digital health—full-stack solutions that
deliver wraparound, holistic care platforms (Rock Health
portfolio companies like Virta, Omada, Vivante, and Brightline)
with high patient engagement and experience drivers baked
into their offerings.
Despite the dramatic increase in live video use in 2020, there’s

still room for digital health offerings to reach demographic
subgroups that haven’t historically engaged in telemedicine
care, as opposed to those subgroups (high-income earners,
middle-aged adults, and those with higher education) that
drove the adoption trend in 2020 and previous years. The 2020
data also exposed other vulnerabilities yet to be tackled in
digital health: most consumers are still reluctant to share
personal healthcare data with many of the stakeholders building
healthcare solutions for them. While the rise of live video
telemedicine is a positive signal for a shift to digitally enabled
care, it continues to be an expensive form of care that is not
quickly or easily scalable.
By surfacing these challenges, we wish to encourage digital

health innovators to keep iterating and leaning in to uncover
areas where adoption doesn’t match the potential for growth.
Rock Health hopes to continue to be a part of the movement
towards reaching a new equilibrium of integrated, affordable,
and scalable use of digital health solutions that support (and
reimagine for the better) a consumer’s care journey.
Get in touch with Rock Health at [email protected] and

the Stanford Center for Digital Health
[email protected].

33
APPENDIX:  
DELAYED CARE
Below is an analysis of those who reported delaying
medical care. Some demographic groups had a higher
propensity to delay medical care than others:33
• After adjusting for covariates, the odds of delaying

medical care increased significantly in younger
respondents.34 Fifty percent of respondents aged 35
to 54 reported that they delayed care, compared to
41% of 18- to 34-year-olds and 35% of those aged 55
and over. 
• Although more men delayed care during COVID-19

than women did (43% versus 41%), after adjusting for
covariates, the odds of delaying medical care are
significantly more in women (OR:1.33; CI: 1.20-1.47;
p<0.001) than in men.  
• Respondents in the Northeast had a higher

percentage of delayed care relative to other regions.
Forty-eight percent of Northeast respondents reported
that they delayed care, followed by those in the West
(43%), South (40%), and Midwest (39%). Regression
analysis shows that the odds of delaying care are
highest in the Northeast region, both in univariate (OR:
1.50; CI: 1.30- 1.73, p<0.001) and multivariate
regression analyses (OR: 1.23; CI: 1.06-1.44,
p=0.007).  
• Surprisingly—and likely to have the most

consequences—respondents with a chronic condition
delayed care more than those without a chronic
condition (48% and 31%, respectively).35  
• Specifically, 47% of respondents with a mental health

condition delayed care significantly more compared to
40% of consumers who did not report having a mental
health condition.36

34
ENDNOTES
1. Telemedicine visits: Data are presented as a percentage where the number of telemedicine visits in a given week is the numerator, and
the number of visits in the baseline week (March 1-7) is the denominator. Telemedicine includes both telephone and video visits. All
types of visits vs. in person visits only: Data are presented as percentage change in number of visits in a given week from baseline week
(March 1-7). Source: Ateev Mehrotra et al., Source: Ateev Mehrotra et al., “The Impact of the COVID-19 Pandemic on Outpatient Care:
Visits Return to Pre Pandemic Levels, but Not for All Providers and Patients,” Commonwealth Fund, Oct. 2020, https://doi.org/
10.26099/41xy-9m57.
2. Survey questions 2015-2020:
1. Survey question 2015-2019: When, if ever, have you received medical care or advice from a healthcare professional (e.g., doctor,
nurse, therapist) through the following means: Live video call on a mobile phone, tablet, or computer (not YouTube or other
educational/information web videos)? Responses: In the last 12 months, More than 12 months ago; Survey question 2020: Have
you received medical care or advice from a doctor or other clinician through the following types of virtual care (i.e., live video)?
Response: Yes.
2. Survey question 2015-2020: Do you own a wearable device or smart watch (note: this excludes smartphones) that helps you track
your health? This could include number of steps/exercise, sleep, heart rate, or blood pressure. Response: Yes.
3. Survey question 2015-2020: How do you currently record the following: Weight, Heart rate, Blood pressure, Medications, Physical
activity (steps, exercise, etc.), Food/diet, Sleep, Blood sugar, Other? Responses: With a wearable, Connected device (e.g., smart
scale, glucometer) or in an app that doesn’t connect to a wearable, In a digital journal or log.
4. Survey question 2015-2020: Have you used a mobile app or website to find any of the following? Responses: A specific physician
or nurse practitioner, An in-home caregiver including private duty nurses, A hospital or clinic, A pharmacy, A nursing home or
long-term care facility, A physical therapist, A psychologist, therapist or counselor, An integrative and or lifestyle medicine
practitioner.
5. Survey question 2015-2019: When, if ever, have you searched for any of the following using a website or mobile app: Information
about prescription drugs and/or side effects, A diagnosis based on your symptoms, Treatment options based on your diagnosis?
Responses: In the last 12 months, More than 12 months ago; Survey question 2020: Have you searched for any of the following
using a website or mobile app: Information about prescription drugs and/or side effects, A diagnosis based on your symptoms,
Treatment options based on your diagnosis? Response: Yes.
Source: Rock Health Digital Health Consumer Adoption Survey (n2020 = 7980; n2019 = 4,000; n2018 = 4,000; n2017 = 3,997;
n2016 = 4,015; n2015 = 4,017).
3. Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Care: Visits Return to Prepandemic Levels, but Not for All
Providers and Patients (Commonwealth Fund, Oct. 2020). https://doi.org/10.26099/41xy-9m57.
4. For further analysis on those respondents who delayed necessary medical care, please see the Appendix.
5. CDC analyzed deidentified encounter (i.e., visit) data from four of the largest U.S. telehealth providers that offer services in all states:
Amwell Medical Group, Boston, Massachusetts; Teladoc Health, Inc., Purchase, New York; MDLIVE, Miramar, Florida; and Doctor on
Demand, Inc., San Francisco, California.
6. Telemedicine users are defined as users of at least one of the six modes of telemedicine included in the survey: live video, live phone,
text messaging, email, health app/website, picture or video messaging.
7. Compared to those without chronic conditions, those with chronic conditions had statistically significant higher odds of using
telemedicine in univariate (OR: 2.76; CI: 2.50-3.05; p<0.001) and in covariate-adjusted (OR: 2.54; CI: 2.25-2.86; p<0.001) regression
analysis.
8. Compared to those with fewer or no doctor’s visits/year, those with 6-10 visits/year had statistically significantly higher odds of using
telemedicine in univariate (OR: 7.27; CI: 5.71-9.26; p<0.001) and multivariate regression analysis (OR: 5.96; CI: 4.57-7.77; p<0.001).
Likewise, those with 10+ doctor’s visits/year had higher odds of telemedicine usage in univariate (OR: 7.37; CI: 5.26-10.35; p<0.001) and
multivariate regression analysis (OR: 5.83; CI: 4.04-8.39; p<0.001).

35
ENDNOTES
9. 35 to 44 year old respondents had significantly higher odds of using telemedicine as compared to other age groups, both in univariate
(OR: 2.94; CI: 2.40-3.61; p<0.001) & multivariate regression analysis (OR: 1.45; CI:1.16-1.81; p=0.001). Compared to younger
respondents, older respondents had significantly lower odds of using telemedicine in unadjusted and covariate-adjusted (55 to 64 years
OR: 0.47; CI: 0.38-0.58; p<0.001; 65 to 74 years OR:0.28 CI: 0.21-0.36; p<0.001 and ≥ 75 years OR: 0.28; CI: 0.21-0.38; p<0.001)
analysis.
10.Compared to women, men had significantly greater odds of using telemedicine in univariate regression analysis (OR:1.47; CI:1.33-1.62;
p<0.001), but the association is lost in covariate-adjusted analysis. (OR: 1.05; CI: 0.94-1.17, p=0.397).
11.Compared to lower income groups, respondents with annual income of $150,000 to $199,999 had significantly higher odds of using
telemedicine in univariate (OR: 3.37; CI: 2.63-4.31; p<0.001) and covariate-adjusted regression analysis (OR:1.70; CI: 1.27-2.27;
p<0.001). Likewise, those with an annual income over $200,000 had significantly higher odds of using telemedicine in univariate (OR:
3.92; CI:3.10-4.94; p<0.001) and covariate-adjusted regression analysis (OR:1.67; CI: 1.25-2.22; p=0.001).
12.Those with Master's, PhD, Graduate/Professional degree had significantly higher odds of telemedicine usage as compared to
respondents with high school, college, and associate/bachelor’s educational attainment, in both univariate and multivariate regression
analysis. After controlling for covariates, the associations between Master's, PhD, Graduate/Professional degree and telemedicine usage
remained significant and odds were significantly greater than other educational groups (univariate: Master's: OR: 4.92; CI: 3.53-6.87;
p<0.001; PhD: OR: 5.94; CI: 3.42-10.32; p<0.001; Graduate/Professional: OR: 4.87; CI: 3.27-7.24; p<0.001 and multivariate: Master's:
OR: 2.81; CI: 1.92-4.11; p<0.001; PhD: OR: 3.32; CI:1.82-6.06; p<0.001; Graduate/Professional: OR: 2.65; CI:1.70-4.14; p<0.001).
13.After controlling for covariates, urban and suburban residents as compared to rural residents had significantly higher odds of
telemedicine usage. Suburban: univariate OR: 1.36; CI: 1.19-1.54; p<0.001 & multivariate OR: 1.26; CI :1.10-1.45; p=0.001. Urban:
univariate OR: 2.47; CI: 2.16-2.84; p<0.001 and multivariate OR: 1.49; CI :1.27-1.74; p<0.001.
14.Telemedicine usage had no significant association with ethnicities except for Hispanics where the odds of telemedicine usage decreased
significantly in univariate (OR: 0.84; CI: 0.74-0.96; p=0.009) and covariate-adjusted regression analysis (OR: 0.82; CI: 0.70-0.97;
p=0.017).
15.The odds of satisfaction with both live video and live phone were greater for younger respondents as compared to older in both
univariate and multivariate regression analysis. The highest odds of satisfaction with live phone call use were found in middle age
groups, both in univariate and covariate-adjusted regression analysis (35 to 44 years OR: 2.08; CI:1.43-3.02; p<0.001; 45 to 54 years OR:
2.17; CI: 1.48-3.18; p<0.001 & 55 to 64 years OR: 2.11; CI:1.43-3.12; p<0.001).
16.Compared to rural & suburban respondents, urban respondents had higher satisfaction with video visits in regression analysis.
(Univariate OR: 2.39; CI:1.72-3.31; p<0.001; multivariate OR: 1.43; CI:0.99-2.05; p=0.05). Regarding phone visits, urban residents had
greater odds of satisfaction in univariate analysis but the association was lost in covariate-adjusted regression analysis (univariate OR:
1.61; CI: 1.23-2.11; p<0.001; multivariate OR: 1.29; CI: 0.96-1.73; p=0.09).
17.The odds of satisfaction with using live video were significantly greater in higher-income groups in both univariate and covariate-
adjusted regression analysis, with the odds being highest in respondents having ≥ $200,000 annual income in unadjusted analysis (OR:
6.31; CI: 3.56-11.16; p<0.001) and after adjusting for covariates (OR: 2.85; CI:1.45-5.59; p=0.002). The odds of satisfaction for live
phone call use also increased significantly as income increased, the odds being highest in respondents with annual incomes over
$200,000 (univariate: OR: 4.31; CI: 2.71-6.86; p<0.001; multivariate: OR: 2.30; CI:1.32-3.98; p=0.003).
18.Respondents identifying as white had higher odds of satisfaction with live phone call in univariate analysis, but the association was no
longer statistically significant in covariate-adjusted regression analysis, while Asian respondents had significantly lower odds of
satisfaction in univariate regression analysis (OR: 0.63; CI: 0.45-0.90; p=0.01) with a trend towards lower odds in covariate-adjusted
regression analysis (OR: 0.70; CI: 0.48-1.02; p=0.06). Likewise, white respondents had significantly higher odds of satisfaction with live
video use in univariate analysis but the association was no longer significant in covariate-adjusted regression analysis.
19.The odds of women not accessing telemedicine were significantly greater in univariate analysis (OR:1.47; CI: 1.34-1.62; p<0.001), but
the association was no longer significant in multivariate regression analysis (OR:1.00; CI:90- 1.11; p=0.96).
20.The odds of not using telemedicine were significantly higher in older age groups, both in univariate and multivariate regression analysis
(55 to 64 years, univariate: OR: 1.32; CI:1.10-1.58; p=0.002; multivariate: OR: 2.57; CI: 2.07-3.18; p<0.001; 65 to 74 years, univariate:
OR:1.48; CI:1.23-1.78; p<0.001; multivariate: OR:4.48; CI: 3.39-5.93; p<0.001 and ≥75 years, univariate: OR: 1.50; CI:1.20-1.87;
p<0.001; multivariate: OR: 4.83; CI: 3.53-6.60; p<0.001).

36
ENDNOTES
21.Odds of not using telemedicine decreased significantly as income increased in both univariate and multivariate regression analysis
($100,000 to $149,999 univariate: OR: 0.44 ; CI: 0.37-0.52; p<0.001; multivariate: OR: 0.70; CI:0.56-0.87; p=0.001; $150,000 to
$199,999 univariate: OR: 0.30; CI: 0.23-0.38; p<0.001; multivariate: OR:0.60; CI:0.44-0.80; p=0.001 and ≥ $ 200,000 univariate: OR:
0.26; CI: 0.20-0.32; p<0.001; multivariate: OR: 0.61; CI: 0.46-0.82; p=0.001).
22.Urban and suburban residents, as compared to rural respondents, had lower odds of not using telemedicine in unadjusted and
covariate-adjusted regression analysis (Suburban - univariate: OR: 0.74; CI: 0.65-0.84; p<0.001 and multivariate: OR: 0.79; CI: 0.69-0.91;
p=0.001. Urban- univariate OR: 0.40; CI: 0.35-0.46; p<0.001; multivariate:OR: 0.67; CI: 0.58-0.79; p<0.001).
23.The odds of not using telemedicine decreased significantly with an increasing number of prescription drugs in univariate and covariate-
adjusted regression analysis (10-12 prescription drugs - univariate OR: 0.12; CI: 0.08-0.19; p<0.001; multivariate: OR: 0.10; CI: 0.06-0.16;
p<0.001. 1-3 prescription drugs - univariate OR: 0.32; CI: 0.28-0.35; p<0.001; multivariate: OR: 0.34; CI: 0.30-0.39; p<0.001).
24.Univariate regression analysis (OR:1.19; CI: 1.05-1.35; p=0.009; multivariate regression analysis (OR:1.20; CI:1.02-1.41; p=0.025).
25.1: Health metrics include weight, heart rate, blood pressure, medications, physical activity, food/diet, sleep, blood sugar, and other. 2:
Analog tracking methods include paper journals or logs, and mental tracking. 3: Digital tracking tools include apps, wearables,
connected devices, and digital journals. Source: Rock Health Digital Health Consumer Adoption Survey (n2020 = 7980; 2019 = 4,000;
n2018 = 4,000; n2017 = 3,997)
26.Percentage of group owning a wearable: Area description: rural=28%, suburban=36%, urban=58%. Income: <$35K=28%.
$35K-74K=35%. $75K-149K=50%. $150K+=73%. Age: 18-34 years old=53%, 35-54 years old=57%,55+ years old=21%. Gender:
man=49%, woman=36%, non-binary and prefer not to disclose: 41%. Chronic condition: chronic condition=46%, no chronic
condition=38%. Education: high school grad and less than high school: 28%, some college, no degree: 28%, associate’s degree and
bachelor’s degree: 41%, graduate or professional degree, masters or PhD=69%.
27.Respondents were able to select multiple reasons for how they were using their wearable.
28.Percent of respondents who stopped using a wearable for one or more purpose: 35-54 year olds (20% vs. 57% of 18-34 year olds and
66% of 35-54 year olds), men (64% of men vs. 42% of women), urban respondents (69% of urban vs. 38% of rural and 40% of suburban),
higher-income individuals (68% of $150K+ vs. less than 55% for all other income groups), and those with chronic conditions (62% of
those with chronic conditions vs. 39% of those without chronic conditions).
29.Average level of trust in all entities: Age: 18-54 year olds (cumulative)=3.46. 55+= 3.16 (10% higher). Gender: Men=3.48, Women=3.23.
Non-binary / prefer not to disclose=2.97 (men 8% higher than women). Area description: Urban=3.56. Rural and suburban
(cumulative)= 3.22 (urban 10% higher).
30.Age: Odds of data sharing with physicians were significantly higher in older as compared to younger respondents, both in univariate
and multivariate regression analysis (55 to 64 years, univariate: OR: 4.28; CI: 3.46-5.29; p<0.001; multivariate: OR: 3.25; CI: 2.56-4.11;
p<0.001; 65 to74 years univariate:OR: 8.68; CI:6.61-11.4; p<0.001; multivariate: OR: 6.55; CI:4.65- 9.23; p<0.001; ≥ 75 years: OR: 10.1;
CI: 6.88-14.9; p<0.001; multivariate: OR:7.83; CI: 5.02-12.2; p<0.001). Gender: Compared to men, odds of data sharing with physicians
were significantly higher in women (univariate OR: 1.74; CI: 1.58-1.92; p<0.001; multivariate: OR:1.46; CI:1.30-1.65; p<0.001). Area
description: Compared to rural, odds of data sharing with physicians were significantly lower in urban residents in univariate (OR: 0.37;
CI: 0.32- 0.43; p<0.001) and multivariate regression analysis (OR:0.71; CI: 0.60-0.85; p<0.001). Ethnicities: Compared to non-whites,
odds of data sharing with physicians were significantly higher for white respondents both in univariate (OR:1.74; CI:1.57-1.93; p<0.001)
and multivariate analysis (OR:1.35; CI: 1.18-1.53; p<0.001). Doctor visits: After adjusting for covariates, those with more doctor visits per
year (as compared to less) were associated with greater odds of data sharing with physicians. For >10 visits/year, odds were highest in
both univariate (OR: 2.11; CI:1.60-2.77; p<0.001) and multivariate analysis (OR: 3.02 CI: 2.19-4.18; p<0.001). Again for 6-10 visits/year,
odds of data sharing with physicians were significantly higher (univariate OR:1.80; CI:1.48-2.20; p<0.001 and multivariate OR:2.17; CI:
1.71-2.77; p<0.001).

37
ENDNOTES
31.Willingness to share COVID status with a technology company: Older age groups, as compared to young, had lower odds of
willingness to share Covid status with a tech company (45 to 54 years OR: 0.66; CI: 0.51-0.86 and p=0.002; 55 to 64 years OR: 0.58; CI:
0.44-0.76; p<0.001; 65 to 74 years OR: 0.31; CI: 0.22-0.45; p<0.001; ≥ 75 years OR:0.40; CI:0.26-0.62; p<0.001). Willingness to share
COVID status with a government organization: Older age groups, as compared to the young, had lower odds of willingness to share
Covid status with a government organization. Odds of willingness to share decreased more in age groups 65 to 74 years and ≥ 75years
(OR: 0.60; CI: 0.45-0.79; p<0.001; OR: 0.60; CI: 0.43-0.84 p=0.003 respectively) than in age group 35 to 44 years and 45 to 54 years
(OR:0.70; CI: 0.56-0.87; p=0.002; OR:0.78; CI: 0.62-0.97; p=0.02 respectively) in covariate-adjusted analysis. Willingness to share
COVID status with a physician: Opposite findings were seen with willingness to share Covid status with physicians and health insurers.
Older age groups had higher odds of being willing to share Covid status with physicians (45 to 54 years OR: 2.00; CI: 1.63-2.44 and
p<0.001; 55 to 64 years OR: 3.95; CI: 3.16-4.95; p<0.001; 65 to 74 years OR: 6.64; CI: 4.85-9.08; p<0.001; ≥ 75 years OR:9.33; CI:
6.16-14.11; p<0.001) in covariate-adjusted analysis. Willingness to share COVID status with a health insurer: Compared to younger
respondents, older age groups had significantly higher odds of being willing to share Covid status (45 to 54 years OR:1.16; CI:0.96-1.41;
p=0.12; 55 to 64 years OR: 1.57; CI:1.29-1.90; p<0.001; 65 to 74 years OR:1.56; CI:1.22-1.99; p<0.001; ≥ 75 years OR:2.27; CI:
1.71-3.02; p<0.001) in covariate-adjusted analysis. Willingness to share COVID status with a pharmacy: Compared to younger
respondents, older respondents had higher odds of being willing to share Covid status with pharmacists in univariate analysis, but the
associations were no more significant after controlling for covariates. Willingness to share COVID status with an employer: Older age
groups, as compared to younger age groups, had significantly lower odds of willingness to share Covid status with an employer in
covariate-adjusted analysis (35 to 44 years OR: 0.71; CI: 0.58-0.87; p=0.001; 45 to 54 years OR: 0.75; CI: 0.62-0.91; p=0.004; 55 to 64
years OR: 0.70; CI: 0.58-0.86; p<0.001; 65 to 74 years OR: 0.40; CI: 0.30-0.52; p<0.001; ≥ 75 years OR: 0.35; CI: 0.25-0.50; p<0.001).
Willingness to share COVID status with family members: Older age groups, as compared to the young, had significantly higher odds
of being willing to share Covid status with family members in covariate-adjusted analysis (25 to 34 years OR: 0.72; CI: 0.60-0.86;
p<0.001; 35 to 44 years OR: 0.74; CI: 0.61-0.90; p=0.002; 45 to 54 years OR: 1.18; CI: 0.97-1.43; p=0.09; 55 to 64 years OR: 1.62; CI:
1.33-1.98; p<0.001; 65 to 74 years OR:1.95; CI:1.50-2.53; p<0.001; ≥ 75 years OR: 2.44; CI:1.79-3.33; p<0.001).
32.Survey question (asked to respondents that answered “a technology company” to the question “which of the following individuals or
organizations would you be willing to share your health information with”): Which of the following technology companies would you be
willing to share your health information (e.g., your medical records, test results, prescription drug history, doctor appointment times,
genetic information, and physical activity data) with? Responses: Amazon, Apple, Facebook, Google, IBM, Lyft, Intel, Microsoft,
Samsung, Uber, None of these.
33.Delayed care group defined by those who answered yes to the question: “During this COVID-19 pandemic period, have you delayed or
avoided medical care that you would have otherwise sought?”.
34.After controlling for covariates, older age groups, as compared to the young had significantly lower odds of delaying medical care.( 55
to 64 years: OR: 0.62; CI: 0.51- 0.76; p<0.001; 65 to 74 years, OR: 0.54; CI: 0.42-0.69; p<0.001; 75 years or older: OR: 0.41; CI: 0.31-
0.55; p<0.001).
35.Compared to those without chronic conditions, the odds of delaying medical care for those with chronic conditions were significantly
higher in unadjusted (OR: 2.07; CI: 1.88-2.82; p<0.001) and in covariate-adjusted (OR:1.92; CI: 1.73-2.14; p<0.001) regression analysis.
36.The odds of delaying medical care were significantly higher in respondents with a mental health condition than those not reporting to
have one in both univariate (OR: 1.27; CI: 1.11- 1.46; p<0.001) and multivariate (OR:1.19 CI: 1.03-1.38; p=0.02) regression analysis.

38
Rock Health accelerates technology-driven solutions The Stanford Center for Digital Health (CDH) is a
that make healthcare and wellbeing vastly more Stanford University resource that provides tools,
affordable, accessible, effective, and equitable. opportunities, evidence generation, and expertise to
further collaboration and promote the School of
Rock Health Venture Fund invests capital in and Medicine’s strategic vision of being digitally driven in all
supports the next generation of iconic healthcare things related to healthcare. Backed by Stanford
entrepreneurs. University and the ingenuity of Silicon Valley, the CDH is
focused on advancing the next generation of healthcare
Rock Health Advisory Services serves strategic
solutions through meaningful collaboration and
innovators within large-scale corporations around the
exploration by helping to build better products, facilitate
globe through its enterprise membership program and
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strategy consulting practice.
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Terumo Medical Corporation, Tokio Marine, and ZS. of health technology leaders by sharing knowledge
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Center for

Digital Health Consumer

INSIGHTS YOU WILL LEARN IN THIS REPORT

• COVID-19’s impact on consumer adoption of

• Which demographic groups were most likely to

• How consumers’ data-sharing preferences

WITH SUPPORT FROM

Clark Seninger, MBA

Nina Chiu, Research Fellow

12 THEME #1: How has telemedicine adoption changed?

22 THEME #2: Who still hasn’t adopted telemedicine?

34 APPENDIX: DELAYED CARE

Digital Health Consumer Adoption Report 2020

The COVID-19 pandemic and ensuing healthcare delivery

Rock Health and the Stanford Center for Digital Health

During the five years leading up to 2020, adoption of

Though not a universal finding, some of the 2020 data

Digital Health Consumer Adoption Report 2020

OUTPATIENT HEALTHCARE UTILIZATION Center for

Digital Health Consumer Adoption Report 2020

This white paper explores the four questions outlined below.

Here are our key findings:

Digital Health Consumer Adoption Report 2020

Key findings continued:

4. How have consumers’ data-sharing preferences changed during the pandemic?

Digital Health Consumer Adoption Report 2020

Since 2015, Rock Health has annually surveyed 4,000 US

A survey of 7,980 US adults was conducted by Toluna

As seen in Figure 2, our survey population closely

Digital Health Consumer Adoption Report 2020

Digital health use in 2020 was a reflection of consumers’

• The quick pivot by providers to offer remote care

• Wearable use was up in 2020, with 43% of all

• Over half of respondents tracked a health metric

• Sixty percent of respondents searched for provider

• The majority of respondents continue to search online

Digital Health Consumer Adoption Report 2020

43% 43% 42%

What follows is an analysis of four key themes emerging in 2020.

Digital Health Consumer Adoption Report 2020

How has telemedicine adoption changed?

TELEMEDICINE ADOPTION BY CHANNEL Center for

Digital Health Consumer Adoption Report 2020

PERCENT CHANGE IN VISITS FROM BASELINE Center for

Digital Health Consumer Adoption Report 2020

1. Page 15: Telemedicine user profiles in 2020 versus 2019

3. Page 17: Channels used to access telemedicine care

Digital Health Consumer Adoption Report 2020

COMPONENT #1: Telemedicine user profiles in 2020 versus 2019

Digital Health Consumer Adoption Report 2020

COMPONENT #2: Reasons why telemedicine users sought care in 2020

REASON FOR SEEKING TELEMEDICINE Center for

LIVE VIDEO CALL 19% 33% 15% 25% 8%

LIVE PHONE CALL 25% 14% 12% 39% 11%

Digital Health Consumer Adoption Report 2020

COMPONENT #3: Channels used to access telemedicine care

MODE OF TELEMEDICINE ACCESS Center for

LIVE VIDEO CALL 8% 70% 6% 13% 3%

LIVE PHONE CALL 7% 60% 6% 20% 6%

• Which demographic groups were most likely to  

• How consumers’ data-sharing preferences  

4. How have consumers’ data-sharing preferences changed during the pandemic?  

• Over half of respondents tracked a health metric  