Spruce Health

So today we’re chatting about Spruce Health and how it’s used at your company. Before we jump into that, could you give a brief overview of the company and your role there?

We’re a mental healthcare provider delivering care virtually through group therapy, individual therapy, and family therapy sessions. I’m a product manager in the engineering organization. We partner with the clinical side of the company to build the tools and platform in which we deliver the care.

What was the core business problem that a tool like Spruce helped you solve?

The core use case for us has been reaching out to patients and their emergency contacts. The two biggest user groups are clinicians themselves who are delivering the care, and our customer support staff who do scheduling and other care-adjacent tasks.

What requirements did you have in mind when searching for a solution?

The first and biggest was being HIPAA-compliant, of course. Feature-wise, we wanted something that could handle the number of contacts we would be entering into the system, on the order of thousands: every patient and then two or more emergency contacts. Then we wanted to be able to search and organize the list. We wanted to search for a contact based on an external ID, to link and tag clients and their emergency contacts, and group certain contacts together based on things like their cohort or time of admission.

What other vendors did you consider during the evaluation process, or who has shown up as a competitor since you chose to use Spruce?

I wasn’t in the original vendor decision-making process, but since then, we’ve come across some use cases that don’t work great with Spruce. One major item was automating our outreach, such as reminders before a session was scheduled to start. Spruce can’t do that, so we ended up switching to Iterable for a lot of our outreach that we could plan ahead of time. We’ve also been thinking of using Google Voice as an alternative, based on cost and visibility. The biggest pain point with Spruce on the clinical side is that we want to have three levels of visibility into patient conversations: clinical staff can only see their own conversations, their supervisors can see those of their clinicians, and admins can see everything. But there’s no ability to filter in Spruce. Google Voice is a lot cheaper, and seems like it might be a little more configurable, but we haven’t fully vetted it yet. We did end up talking with Spruce’s CTO and it seems that they’re willing to add these features to their road map to support our use case. So we really liked that they ended up being responsive to our needs.

Can you describe the way Spruce is incorporated into your work flows?

The first area is the clinical side. Clinicians can reach out to a patient’s emergency contact if they have concerns about the patient’s safety. So first they would check in our EHR system that we have permission to reach out about something that’s been discussed in sessions. And then the clinician would search in Spruce by the client’s name and find their emergency contact. They can send a text or a phone call.

Clinicians can also use Spruce for documentation. If they reach out to an emergency contact, that needs to be documented in our EHR system, Elation. They create a new note manually in Elation and then type out the specifics of the outreach. We had actually talked with Spruce about adding this as a potential new feature, to automatically add a note in Elation, but it turns out that it wouldn’t have helped our process much. A lot of contacts aren’t actually clinically relevant, like scheduling calls, and the clinician decides whether a particular contact qualifies. And also, while Spruce and Elation do have some level of integration, it’s not seamless. The clinician generally copies and pastes the text messages into Elation, or if it’s a phone call, they type up a summary of the conversation. Elation does have a bulk import feature to add a bunch of texts at once, but that’s still not helpful, because we only want it to import texts of a certain kind.

The second work flow is the customer support and scheduling side. Most of the scheduling happens in a decently automated way: when a client is first admitted, they’re scheduled for recurring sessions with a primary therapist and with their group. But a lot of times clients need to make one-off schedule changes or want to switch therapists, and that has to be done manually on our end. There’s no self-service way to do that from the client side. So they have to talk to an admin, and they generally coordinate that through texts or phone calls through Spruce.

What is the UI experience like?

You can access Spruce on your computer through a web interface, or on your phone through a mobile app. The UI is pretty decent compared to some of the others we’ve seen in healthcare products! The design is good. Most of our requests are around the functionality, not the UI.

Could you talk about how you’re using Spruce and Iterable in tandem?

So at a high level, Spruce is the system we use for one-off unplanned communication, and then Iterable is the one we use for pre-planned, pre-scheduled communication. Spruce does have scheduled bulk messaging features, but they’re fairly limited. You can schedule a message to be sent to an individual client, or you can create a list of clients to bulk message. But we wanted interoperability with our other systems so that, for example, a client gets a reminder message 15 minutes before their session and it’s personalized with the specific time, Zoom link, and session name. We would have to do that all manually in Spruce.

How would you characterize the overall strengths and weaknesses of Spruce?

The UI is a strength: it’s relatively bug-free, it’s stable and reliable. The weakness is the limit in functionality and use cases it supports. It makes sense since the company is relatively small and the roadmap is still being developed.

What would an ideal solution for your needs look like?

The biggest functionality would be the interoperability piece: being able to pull certain attributes or events from other platforms to trigger events in Spruce would be huge, and conversely being able to pull conversation data from Spruce into our EHR. The other function would be enabling our specific clinical workflow and structure, where each level has the right view for their specific responsibilities: clinicians can see just their patients, while clinical directors can see their own clinicians.

Is Spruce integrated with any of your systems other than your EHR? How is the integration experience?

We haven’t opted in to integration with our other products because of the limitations in interoperability. The integration with Elation is limited and wasn’t really going to save us any time, so we opted not to turn it on. Being able to pull contact data from Salesforce during the admissions process would be nice to have. Right now that is all happening manually because of the lack of integration: someone goes into Salesforce, copies new contacts, and adds them manually into Spruce, tagging them with their cohort group and other relevant information. All the maintenance of contact info is done manually too.

How has the account management and support experience been?

They’ve been really responsive. They’re a small team, but they’ve answered all our emails and requests basically within an hour. We’ve had calls with their CTO where he explains a certain functionality, or we talk about a lack of functionality and he adds it to the roadmap. There have been smaller features that we’ve requested that we’ve actually seen implemented.

Looking back, do you think you made the right decision moving forward with Spruce?

Yeah, I think at the time it made sense. And I don’t think overall people regret it. I think just based on the change and growth within our own company, Spruce might not be the right product for our future state.

Any advice you have for folks that might be looking for a similar sort of tooling?

I think it depends on the size of the company. Because of the lack of interoperability, you might have to contend with a lot of manual reconciliation. For a smaller company. I think that’s well worth it, especially for the reliability Spruce offers. And that’s the position we were in. But as we’re scaling, all that manual work is becoming near untenable, and so we’re looking for better solutions.