Secure Messaging with Patients

Introduction to Secure Communication 

Secure messaging is one of multiple ways you can communicate with your patients on Spruce. The other means is via standard SMS or email. You can learn more about standard SMS on Spruce here.

Secure messaging requires that you have invited a patient to create a secure account and that they have accepted and completed the steps to create their patient Spruce account. After the patient has created their account, you can begin exchanging secure messages. 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. 

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 Action button with the pencil and paper icon 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

1. Navigate to your contacts tab.  
2. Select the "+" button on the bottom right-hand corner.
3. Select "Create Contact."
4. Enter in their contact information and select "Save."
5. Then select "Invite to Spruce." 
6. 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

1. Navigate to your contacts tab.  
2. Select the "New Contact."
3. Enter in their contact information and select "Save."
4. Then select "Invite to Spruce."
5. 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:

1. Start by initiating a secure message to your existing contact (either from the inbox, or from your contacts as described above).
2. 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".
3. 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 messaging 

In addition to one-to-one secure messaging like described above, we also support group secure messaging. Group secure messaging can include multiple patients who have secure Spruce accounts. If you have teammates on your Spruce account, you could also send a group message that includes both patients and teammates.  

Group messages will have a blue group icon so that you can identify a group message from the inbox view. To view the participants of a group message, you can select the (i) icon in the top right hand corner of the screen. 

We do not support group SMS (text) messaging, in order to create a group message all participants in the group must have secure Spruce accounts. 

To create a secure group message:

From the mobile app

1. Navigate to the inbox.
2. Select the Plus + icon and then select secure message.
3. Type the names of multiple existing contacts (patients or teammates) to send a group secure message. 

From the web

1. Navigate to the inbox.
2. Select the action button with the paper and pencil icon and select secure message. 
3. Type the names of multiple existing contacts (patients or teammates) to send a group secure message. 

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: 

1. Select any secure patient conversation.
2. Click into the conversation details by selecting the "i" icon in the upper right-hand corner.
3. Scroll down and select "Make Conversation Read-Only."
4. 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 

1. Click into any secure patient message. 
2. Hover over the specific message you'd like details on until you see the 3 vertical dots (the menu) appear.
3. Click on the menu and select "Show Message Details." 
4. You'll see "Sent by" and "Seen by" information on the right-hand side. 

From the mobile app

1. Click into any secure patient message.
2. Select the specific message you'd like details on by clicking down on it. 
3. Click on "View Message Details" from the menu.
4. You'll see "Sent by" and "Seen by" information 

Not using Spruce yet? Learn more here.