ekco vs Spruce

Spruce is phones and team inbox. ekco executes the care plan on healthcare iMessage between visits.

Feature comparison: ekco vs Spruce for between-visit care plan execution
Feature	ekco	Spruce
Phone / SMS / fax / video	Not our job	Core product
Shared clinical inbox	Exception queue	Core product
Scheduled between-visit check-ins	Check-ins on healthcare iMessage patients reply to	Staff-driven templates, not a scheduled plan
Care plan follow-through	See who is on the plan and who needs a nudge	Not a care-plan state machine
Two-way patient texting on the plan	Two-way healthcare iMessage on the treatment plan — replies stay in the thread	Ad hoc / template SMS, not plan-tied
Escalate when someone falls off	Exception queue when replies signal risk or non-adherence	Staff-driven
Patient confirmed reorder in thread	Reorder prompts from the plan in the same thread — clinic keeps the sale	Not a plan-tied reorder
Pricing model	Per active patient	Per seat

Public product pages checked October 2026.

Who should pick what

Choose Spruce if

You need a team communication hub with phone, SMS, fax, and video in one BAA-covered product.
Your budget is per-seat comms infrastructure.

Choose ekco if

A shared inbox is not executing the care plan on a schedule.
You want check-ins on the plan and an exception queue, not manual SMS from staff.

What Spruce is

Spruce describes itself as HIPAA-compliant healthcare communication: secure messaging, phone with two-way SMS, video, e-fax, team inbox, and workflow automation with per-user pricing. Public list prices have been about $24 and $49 per user per month for Basic and Communicator. Confirm current rates on Spruce. See sources.

What ekco is

ekco takes a clinician-directed care plan and keeps the patient moving on it between visits — check-ins and running-low texts on healthcare iMessage, where patients already reply. Not another portal login or a team inbox.

Staff see who is following the plan and who needs a person. You keep clinical judgment. ekco is not your EHR, chart, or billing system. It doesn’t book appointments and doesn’t take payment.

Spruce is where staff talk to patients ad hoc. ekco runs the plan between visits.

Spruce is phones, fax, video, and a shared inbox for the care team. Clinics sometimes use it as a substitute for follow-through — but ad hoc messaging is not the same as running the plan.

Can I use Spruce and ekco?

Yes. Spruce for phones and team inbox; ekco for care-plan execution and Patient Store reorders in the same iMessage thread.

Bottom line

Spruce is a substitute — communication infrastructure — not care-plan execution.

Questions

Can I use Spruce and ekco together?

Yes. Spruce covers phones, team inbox, fax, and video. ekco runs the clinician-directed care plan on a schedule in healthcare iMessage, with an exception queue and Patient Store reorders in the same thread.

Spruce vs ekco for between-visit patient texting?

Spruce is built for staff-driven, ad hoc patient communication. ekco is built for protocol follow-through — check-ins, running-low nudges, and reorders tied to the care plan, not manual inbox work.