Secure Messaging is one of multiple ways you can communicate with patients on Spruce and is an encrypted, app-based communication method. Unlike standard SMS (learn more about SMS on Spruce here), these messages are sent via a Spruce Link rather than a phone number. To begin, a provider must invite the patient, who then creates a secure Spruce account. Providers can initiate conversations from the Inbox or a Contact and can maintain multiple distinct threads with a single patient (e.g., separating billing from clinical care). Secure conversations feature read receipts, attachments, Activity Reminders, and support group messaging for up to 20 participants.
An important quality of secure messaging is all communication between you and the patient occurs within the Spruce application, which includes HIPAA-grade encryption and other controls for all information exchanged, both when the information is stored and when it's being transmitted. You can read more in our white paper, Using Spruce in a HIPAA-Compliant Manner.
If you haven't already you may want to review Spruce article, Inviting Patients to Spruce before or after reading this article.
IN THIS ARTICLE
- How to send Secure Messages
- Creating multiple secure conversations for one patient
- Receiving secure messages
- Group secure messaging
- Making a conversation read-only
- How to view read receipts
- Hyperlinks
- Data in Patient Accounts
- Activity Reminders
How to send Secure Messages
To send a secure message on Spruce you will need to define the message recipients (who will receive the message), and who the message is from. When you send an SMS (text message) on Spruce, it is sent from a Spruce phone number. When you send a secure message on Spruce, it is sent from a Spruce Link. The default for every account on Spruce is to have only one Spruce Link. When coming from your Spruce Link it is coming from your Spruce app to the patients Spruce app or web sign on.
There are a few different ways that you can initiate a secure message. We will walk through all the possible paths so that you are familiar, please follow whichever means feels most intuitive for you.
From the Inbox
Initiate a secure message for a new conversation
From the mobile app
To initiate a secure message for a new conversation, navigate to the inbox, select the Plus + icon and then select secure message.
From the web
Navigate to the inbox, select the "New" button and select secure message.
Then you can type the name of an existing contact and select their contact to send them a secure message. If you type the name of an existing contact who has not been invited to Spruce, you will be prompted to invite them. If you want to send a secure message to someone who is not yet saved as a contact in Spruce, you can enter their phone number and then select the prompt to "Invite Patient to Spruce."
Initiate a secure message from an existing conversation
You can send a secure message from any existing secure conversation. Secure conversations are denoted by the blue icon with the patient initials (compared to a grey icon that indicates a phone/SMS conversation). Open a secure conversation, select "Message" at the bottom, compose your message, and select Send.
From Contacts
Initiate a secure message for a new contact
From the mobile app
- Navigate to your contacts tab.
- Select the "+" button on the bottom right-hand corner.
- Select "Create Contact."
- Enter in their contact information and select "Save."
- Then select "Invite to Spruce."
- Once they create their account, you'll be able to initiate a new message by clicking into their contact and selecting the "message" icon (small blue lock). This icon will be gray until they create their account.
From the web
- Navigate to your contacts tab.
- Select the "New Contact."
- Enter in their contact information and select "Save."
- Then select "Invite to Spruce."
- Once they create their account, you'll be able to initiate a new message by clicking into their contact and selecting the "message" icon (small blue lock). This icon will be gray until they create their account.
Initiate a secure message for an existing contact
Navigate to your contacts tab and find the patient you'd like to message. Ensure that the icon next to their name is blue, indicating that they've downloaded the app. If they were invited to download the app but haven't yet, feel free to select "Resend Spruce Invite" within their contact. Learn more about inviting them to the Spruce app here.
If the contact has already been invited and created their Spruce patient account, you can press the blue lock icon under their contact name to send them a secure message. If there are existing secure messages with this contact you can choose to send a secure message within the existing conversation or send the secure message in a new conversation with this contact.
If the contact has not created their Spruce patient account, you will see that the message lock icon is grey. You can press the button under their contact name to invite them to join Spruce. After they have accepted their invitation, you will be able to send them a secure message.
Defining the 'from'
If you have one Spruce Link on your account the "from" will default to this Spruce Link. If you have multiple Spruce Links on your account, you can select one Spruce Link to be defined as the from. For example, if you have multiple clinicians at your clinic, you may want it to come from your direct Spruce Link vs the clinic. This way all messages with this patient will follow the rules you set for ownership of this Spruce Link. You can choose who is a member of a specific Spruce Link and only members will be able to see incoming correspondence to that Spruce Link and will be able to initiate conversations from that Spruce Link. Create and manage your Spruce Links in your settings under "Secure Messaging."
Creating multiple secure conversations for one patient
You can elect to have one ongoing thread of communication with one patient, or you can create multiple secure threads of communication. A reason you may want to have multiple threads is if you would like to segment administrative conversations from clinical conversations––for example, you may create a secure conversation with the subject line of "billing" or "membership" to converse with that patient of the status of their payments. You may then create another conversation with the same patient with the subject as "clinical care" to have your ongoing discussion of their continued care. The patient will see these as different threads in their patient app all from you but will also see the Subject line.
To create a second conversation:
- Start by initiating a secure message to your existing contact (either from the inbox, or from your contacts as described above).
- On mobile below the From you will see "Respond below or create a new conversation", on web it will show you the current patient secure conversation or to the left you can create "new conversation".
- Select "new conversation" and it will prompt you to create a new conversation with this existing contact. You'll be able to find all conversations with a patient within their contact in your Spruce contact book.
TIP: If you create a new conversation, make sure to add a Subject line saying what it's about.
Have multiple clinicians with multiple Spruce links?
You have the option to choose which "From" or Spruce Link you want this to come from. If the one in the From is not your Spruce Link, you can tap to choose a different one. This will enable the new conversation with this patient to follow the assignment rules or customizations (e.g. tags) you have setup under your Spruce Link. Read more about Spruce Link Ownership here.
Receiving secure messages
When you receive a new secure message you will see a badge notice of new activity in your inbox. You can reply to this secure message by clicking into it, composing your message, and selecting send. Patients will receive this message in their Spruce patient app.
Group secure messaging
In addition to one-on-one secure messaging, Spruce also supports group secure messaging—similar to a group text thread on your phone, but entirely within the secure Spruce app.
You can start a group secure message that includes:
Multiple patients (as long as they have secure Spruce accounts), or
Patients and practices—including external practices that also use Spruce
This allows for seamless, secure communication across care teams and patient groups, whether within your organization or with external collaborators who are also on Spruce. Group secure messages support up to 20 participants in total.
If you’d like to communicate with people who do not have a secure Spruce account, you can also send a group SMS message to a set of phone numbers. This enables convenient outreach while coordination in a shared thread.
Group secure messages are easy to identify—they appear in your inbox with a blue group icon. To view the participants in a group thread, tap the (i) icon in the top right corner of the screen.
To create a secure group message:
From the web
- Navigate to the inbox.
- Select the "New" button and select secure message.
- Type the names of multiple existing contacts (patients or teammates) to send a group secure message.
From the mobile app
- Navigate to the inbox.
- Select the Plus + icon and then select Secure Message.
- Type the names of multiple existing contacts (patients or teammates) to send a group secure message.
To add/remove participants from a secure group message:
From the web
- Navigate to a secure group conversation.
- Click on the info 'i' in the top right corner.
- Click the Edit option next to "Conversation Between."
- Hover over a participant and click the X button to remove them.
- Use the search field to add a participant.
- Click the Save button.
From the mobile app
- Navigate to a secure group conversation.
- Select on the info 'i' in the top right corner.
- Select Manage Participants.
- Select the three-dot menu, then Remove to remove a participant.
- Select Add Participant, search for the participant you wish to add, and follow the prompts to add them to the conversation.
Note: When you add a new participant to a secure group message, they will not see any past messages in the conversation. When you remove a participant from a secure group message, they will still be able to view past messages but will no longer be able to send messages or see any new ones in that conversation.
Demo Video Group Secure Messaging Overview (Provider + Patient View)
Making a conversation read-only
You have the option to make any secure conversation "Read only." Making a conversation "read-only" means that you and your team won't be able to continue messaging through that specific conversation and will need to generate a new conversation with that patient if you'd like to continue reaching out. This is helpful if the conversation was regarding a specific topic that has already been addressed or if a patient has left your practice.
To mark a secure conversation as read-only:
- Select any secure patient conversation.
- Click into the conversation details by selecting the "i" icon in the upper right-hand corner.
- Scroll down and select "Make Conversation Read-Only."
- You will notice that the name of the conversation will include "Inactive."
You can undo this action any time by following the steps above and selecting "Reactivate Conversation." Even if you choose to make a conversation read-only, you will still be able to initiate new conversations with the patient and view all correspondence in their contact card.
Please note that the patient will see that you've closed the conversation on their end and they will be unable to communicate with you in this conversation.
How to view read receipts
You'll be able to see if a patient has viewed your message with the specific date and time it was seen.
From the web
- Click into any secure patient message.
- Hover over the specific message you'd like details on until you see the 3 vertical dots (the menu) appear.
- Click on the menu and select "Show Message Details."
- You'll see "Sent by" and "Seen by" information on the right-hand side.
From the mobile app
- Click into any secure patient message.
- Select the specific message you'd like details on by clicking down on it.
- Click on "View Message Details" from the menu.
- You'll see "Sent by" and "Seen by" information
Hyperlinks
You can easily turn any text within a message on Spruce into a hyperlink, making it easy to share links, without negatively impacting the readability of the message. Hyperlinks can be used in external messages (secure or SMS), as well as internal messages and team messages. There are two ways to hyperlink in Spruce:
Option 1: Highlight the word you want to hyperlink, click the 'insert link' icon, enter your link in the pop up and select 'save'.
Option 2: Highlight the word you want to hyperlink, use the shortcut "Command K" to open the pop up window, then enter your link and select 'save'.
If you want to make changes, or remove, an existing hyperlink, just hover over the hyperlink and select 'edit' or 'remove'.
Note: At this time, embedding hyperlinks in text is only available on Spruce's desktop and web apps.
Data in Patient Accounts
Patient accounts on Spruce retain copies of all secure messages that you exchange with them. Patient access to this messaging history is not dependent on your organization remaining a customer or active user of Spruce, and any messages present in a patient account will persist past organizational cancellation or deletion, unless the patient also elects to delete their account. Secure messages that you have deleted from a patient conversation will no longer be visible to the patient in the Spruce app but may be retrievable via record request or legal proceedings. Providers on Spruce cannot delete patient accounts.
Activity Reminders
Activity Reminders are email or SMS notifications sent to patients to alert them of new, unread activity in Spruce. Their primary purpose is to ensure that Spruce activity is not missed and acted upon in a timely manner. For patients, they are enabled by default. Read more about activity reminders here.
Frequently Asked Questions
What does a patient need to do before receiving secure messages on Spruce?
The patient must accept the provider's invitation and create a secure Spruce account; after that, secure messages can be exchanged through the Spruce app or web.
Does Spruce support group secure messaging and read-only conversations?
Yes, providers can create secure group messages with up to 20 participants and add or remove participants over time; any secure conversation can also be set to read-only to stop new replies while preserving the history. Providers can create multiple separate secure threads with the same patient.
Not using Spruce yet? Learn more here.