Modern Communication for Healthcare

We’re excited to announce the launch today of Care Messenger on web, IOS, and Android. Care Messenger is a reflection of our vision for the future of healthcare delivery, and an extension of our work building and operating the Spruce Dermatology Clinic over the past two years. This inaugural blog post shares that vision, discusses key lessons learned with Spruce Dermatology Clinic, introduces Care Messenger, and provides a window into our roadmap from here.

Our Vision

Spruce was founded in 2013 based on three key assumptions about the future of healthcare delivery.

  • The majority of health encounters will be digital and take place with patients using mobile devices. Mobile access to services has come to dominate every other part of our lives as consumers, and healthcare will be no exception. The shift to digital, mobile care will come in part from existing encounters moving to telemedicine when patients do not need to be examined in person. Studies suggest that as many as 50% of doctor visits could be completed virtually, and this percentage is likely to increase as we see more innovation in connected device diagnostics.1 The low-friction access that digital care enables will also significantly expand the number and type of encounters, with vast potential to improve health and the management of chronic disease. In both cases, technology can enable simultaneous improvements in the quality and value of these interactions to both patients and providers.
  • Asynchronous interactions will be the dominant modality for care. This assumption may seem less obvious, but in our opinion it shouldn’t be. After all, asynchronous interaction is the primary pattern on mobile, with messaging apps dominating usage and sessions.2 Messaging is a preferred consumer behavior to video calls and messaging threads are increasingly utilized as the platform for all types of advanced workflows. Moreover, software can create efficiencies within asynchronous interactions in ways that don’t work in a synchronous context. With messaging and software-enabled care workflows, 10 minutes of well-spent patient time may translate into only 1 minute of provider time. The same efficiency simply cannot be achieved within a live conversation (either in-person or on a video call).
  • Well-designed software will make both giving and receiving care more human, not less. We think technology receives a bit of a bad rap in healthcare. This is driven in large part by an EHR hangover, as physicians who adopted EHRs for regulatory or billing reasons find themselves confronted with technology that was not designed with their workflows in mind and often gets in the way of providing care. This need not be the case. We think software should complement physicians, not compete with them or distract them. It’s crazy that a full quarter of physicians spend more than 40% of their time on administrative work.3 We’re building software that will enable physicians to focus on the work that they love and are uniquely trained for — building relationships and making clinical judgments – and less time on repetitive or rote activities.

Spruce Dermatology Clinic

Based on the vision described above, we set out in August 2013 to build the most advanced software platform for digital care delivery. A year later, we took it to market via the Spruce Dermatology Clinic, which connects consumers with board-certified dermatologists for remote diagnosis and treatment of common dermatological conditions via asynchronous virtual visits (“Spruce Visits”). Over 18 months operating the clinic, we’ve both validated our assumptions about the promise of digital care, and deepened our understanding of where good software can contribute.

Specifically, Spruce Dermatology Clinic successfully highlights the ability for a mobile-first, asynchronous care delivery platform to improve both access and efficiency:

  • For patients: The average wait in the US for a dermatologist appointment is 29 days, but on Spruce Dermatology Clinic patients receive treatment plans from their dermatologists in just a few hours — 100x faster than the status quo.
  • For dermatologists: Spruce software dramatically streamlines treatment, making it possible for a dermatologist to diagnose and treat a case in just a couple minutes (with no additional admin work or overhead costs), at a $40 price point.

These numbers underscore that Spruce makes giving and receiving care easier and faster, but they don’t capture perhaps the most important fact: patients and their doctors love the experience and find it natural. In addition to press reviews of the patient experience (Vogue – “In a word:priceless”), patients consistently rate Spruce as 5 stars across App Store, Yelp and in-app reviews, and 95% tell us that they’d encourage others to use Spruce.  For dermatologists, the net promoter score is 100, meaning that every doctor on Spruce said that they would recommend Spruce to a friend or colleague.

Running the Spruce Dermatology Clinic has also led us to a key insight about the interaction patterns patients and care teams value in the context of advanced digital care. While the Spruce Visit itself – the adaptive, asynchronous interview that collects the patient’s symptom and medical history – is essential for remote treatment at the standard of care, the “magic moments” typically occur in the surrounding conversations, and often as a direct result of dermatologists and care coordinators on Spruce being in sync and highly communicative.

  • Patients rave about proactive messages (e.g., sending them Rx coupons or checking in on progress) from their care coordinator or doctor, and deeply appreciate how much easier it is to get answers to simple questions.
  • Dermatologists say they wish it was as easy to stay coordinated with their staff during their “day jobs”, and that they love having a “digital doctors’ lounge” for second opinions and comparing best practices.

You could say that we discovered in the digital world what many physicians already know in the analog world: great communication is the foundation of great care. As a result, we’ve spent the last six months focusing our product development efforts on helping care teams and patients communicate better, regardless of specialty or setting. This brings us to today’s release of Care Messenger.

What is Care Messenger?

Care Messenger is designed to be the best way for healthcare providers to communicate with their patients, and amongst themselves. The product is described in detail on our main page, but in short it enables unified, multi-channel communication with patients, and keeps care teams in sync.

It’s based on a few product tenets, which reflect our learnings to date:

  • The power of a conversational interface. Whether a provider is having a text message or email exchange with a patient, making or receiving voice calls against a dedicated Spruce line, or in-app messaging with other care team members, all communication is unified and documented within a conversation thread.
  • Telemedicine is an extension of messaging. Spruce Visits aren’t going away – they’re coming soon to Care Messenger with a new, long list of primary care complaints. They’ll live as “attachments” within the context of a messaging conversation, and enable providers to capture all of the information necessary to treat remotely (and efficiently!) at the standard of care while providing a convenient patient experience.
  • Flexibility and modularity. Healthcare providers can flexibly adapt Care Messenger to their practice workflow, regardless of preferred communication channel (app, email, voice, SMS), interest in telemedicine (take it or leave it), patient preferences (app-savvy or not), team composition (solo or multi), and payment model (fee-for-service or value-based).
  • Self-service. There is no need to talk to a salesperson, pull out a credit card, or vet the platform with colleagues. Any healthcare professional can get started individually, within minutes. We’ve removed all friction because we’re confident that once someone starts with Spruce, they’ll find more and more ways to use it to improve care and productivity.

What’s next?

While we think every healthcare professional can benefit from Care Messenger in some way in its current form, our release today is just the first step. Our next major release will let providers invite patients to connect with them on Care Messenger for in-app messaging and Spruce Visits. From there, we’ll be continually layering new “attachments” into messaging threads to enable more complex digital care workflows.

It’s also worth a quick word on the relationship between Spruce Dermatology Clinic and Care Messenger. We expect Spruce Dermatology Clinic to continue to grow. Think of it as the largest customer of our digital care delivery platform and a showcase for the full functionality of our underlying software. As we progress through our roadmap for Care Messenger, any healthcare provider using it will be able to access all of the same functionality and “attachments” Spruce Dermatology Clinic currently utilizes. This means that any forward-thinking practice can gain the same efficiency and patient and physician experience advantages of Spruce Dermatology Clinic for themselves.

If you’re a healthcare provider, we hope you’ll get started today on Care Messenger and let us know what you think. In fact, you can chat with us directly within the Spruce app via the @SpruceSupport conversation thread. Talk to you there!

-Team Spruce


  1. Deloitte Study, eVisits: the 21st Century Housecall
  2. Messaging apps are 6+ of top 10 most used apps globally and have the most sessions. KPCB Internet Trends
  3. CareCloud Study, 2014 Practice Profitability Index

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