Spruce Backup System

Introduction to the Spruce Backup System

Spruce customers rely on our platform for vital communication with patients and colleagues. To provide the best service to our customers, Spruce has developed a Backup System that we can engage to manage communications and inform customers if a platform-wide incident should occur.

While we do not anticipate outages, this contingency plan ensures that you can access inbound communication and that your patients are appropriately notified in the event that Spruce were to become temporarily unavailable. This article describes our plan in detail so that you can be prepared to best serve your patients in the event of an outage.

Staying informed of incidents

Spruce maintains a status page at https://status.sprucehealth.com. In the event of an incident that affects the Spruce platform, we update the status page with a summary of the impact and the affected components. For timely updates, you can select Subscribe to Updates in the top right corner of the page to receive status updates via email and text message.

Managing inbound communication during an incident

In the event that Spruce becomes inaccessible, our engineering team will assess the situation, and they may decide to turn on our Backup System. Engaging the Backup System is a manual action that we will only carry out in the event of a serious, platform-wide incident that impacts a significant number of Spruce customers.

The Backup System will accept inbound communication, notify you of inbound communication intended for your organization, and inform your patients that responses may be delayed. Once the disruptive incident has been resolved, all inbound communication from the incident period will transfer to your Spruce Inbox as usual, and any notifications you would have normally received will be triggered.

Here’s what your patients, callers, and fax senders will experience in the event of such an incident:

Channels with Backup System modifications:

Calls: The caller will hear a message that the phone system is currently experiencing an outage, that they should call 911 in the case of an emergency, and that they should try their call again later if it is not an emergency.
Faxes: In most cases, Spruce can continue to accept faxes even if the Spruce inbox is inaccessible. If we are unable to accept an incoming fax, the fax will be rejected and the sender will be notified of a send failure.
SMS text messages: The sender will receive an automated reply informing them that the system is currently experiencing an outage and that their provider may not see their message until the system has been restored.

Channels without Backup System modifications:

Secure messages: Any secure messages in transmission at the time of an outage will be delivered to your inbox once the system has been restored.
Email: Spruce is able to accept inbound email during outages and will deliver such messages to their intended Spruce inboxes in a delayed manner once the system has been restored.

Setting Up The Backup System

To opt-in to receive email and SMS notifications in the event of a system outage, navigate to your Spruce settings, then select "Backup System", then "Set Up Backup System Notifications". From there, you can select notification type (only email or email and SMS) and enter the email addresses / phone numbers for those that should receive the notifications.

**Please note: only organization admins can configure this.

Notification of inbound activity

For all types of inbound communication, the Backup System can inform you in real time of inbound communication you have received and provide a way for you to access that communication without needing to log into Spruce.

For every inbound communication attempt, you can choose to be notified by email only, or by email and SMS text message:

Email notification: If you provide email addresses to receive Backup System notifications, every email address listed will receive an email with a link to information regarding each communication attempt received during an outage. The links are valid for 12 hours. Selecting the link will give you access to the following information for each type of inbound communication:
- SMS text messages: Time of message, sender’s phone number, destination phone number, and content of the message.
- Fax: Time of fax, sender’s fax number, destination fax number, and link to PDF of the fax.
- Calls: Time of call, source phone number, and destination phone number.
- Secure messages: Outages will typically prevent patients and other third parties from being able to send secure messages to your organization. As such, there should not be inbound secure messages needing notification during outages.
- Email: You will not receive Backup System notifications for inbound emails, but such emails will be stored and delivered to your inbox following any outage.
SMS notification: If you provide SMS-capable phone numbers to receive Backup System notifications, we will send a text alert as an extra notification in addition to the emails described above. These text alerts will indicate only that that you have inbound activity accessible via the links that have been emailed to you.

Security of notification links

For security purposes, the notification emails described above do not contain any sensitive information; they will only include a link to such information. These links expire after 12 hours, the text of the links does not directly encode any content, and the link URLs are randomly generated and designed to be of sufficient length and complexity as to be unguessable.

Despite these security features, because content would be viewable by anyone with access to the link during its active lifetime, we strongly recommend that all email addresses on your Backup System notification list be housed on email systems that support TLS encryption (messages will be encrypted during transit with this functionality) and with which your organization has a BAA, as applicable.

Managing outbound communication during an incident

In the event of a platform-wide incident, you will not be able to make outbound calls, use Spruce VoIP desk phones, or send SMS messages, secure messages, or faxes through Spruce. Through the email notifications described above, the Spruce Backup System will provide you with the phone numbers for everyone who attempts to contact you during an incident. You can then respond via any non-Spruce communication system of your choice.

Limitations

While we have developed a Backup System, we continue to investigate additional ways to prevent or mitigate possible points of failure. While unexpected, there are a few scenarios in which the Spruce Backup System would not be effective. These include:

A partial outage in which such a small number of users are impacted that we cannot invoke the global backup system
An outage at the level of our telephone or fax carrier which severs the communication between Spruce and the carrier
A local or regional internet or network outage on the customer’s end that makes it impossible for them to access the Spruce inbox or receive calls on their desk or cell phones

We are always happy to discuss holistic approaches to contingency planning with our customers, including options for redundant internet or phone connectivity. Please contact our Support team for any questions or special considerations.