Referral conversations vs direct messages, and what belongs in each

Both kinds of conversation live under Messages in the sidebar, and the unread count there covers both. The tabs at the top of the list separate them: All shows everything, Referrals shows conversations attached to a referral, and DMs shows direct messages between two people.

A referral conversation inherits the referral's access rules and its consent gate. A direct message has no referral behind it, so it has no patient context and no consent record to sit behind. Which one you are in decides what is appropriate to write.

You can tell them apart from inside the thread. A referral conversation names the patient at the top, shows the referral's status, and offers Open Referral. A direct message names the other provider and reads Direct Message underneath, with a warning banner across the top and no link to any referral.

Open a referral you sent and the sidebar carries a Conversations card; on one you received it reads Conversation, because there is only one, with the practice that sent the referral. Selecting a row opens the messaging panel for that thread, where you can write, attach files, and read the history. The same threads appear under the Referrals tab in Messages, so you can work from either place.

A thread is scoped to one referral and one recipient practice. If you sent a referral to three practices, you have three separate conversations, and no recipient practice can see the messages you exchanged with another.

Before anyone has written, the row states where the thread stands: Not yet notified for a recipient who has not been told about the referral yet, and No messages yet · Notified for one who has. On a referral where no recipient has been notified, the panel reads Waiting for recipients to join.

A direct message is a conversation between you and one other provider, with no referral behind it. Open Messages, select New Message, and search for the provider by name. The search returns clinicians in your category, including those at other practices.

Because there is no referral, there is no patient, no consent record, no referral status, and no Open Referral link. That is what makes it the right place for the questions that are not about a specific case, and the wrong place for the ones that are.

Every direct message thread carries a warning across the top that cannot be dismissed: Do not share protected health information (PHI) in this conversation.

Anything about a specific patient belongs in that patient's referral conversation. Names, contact details, dates of birth, clinical findings, scans, and records all have a referral to sit behind, and that referral is where the consent, the access rules, and the audit trail already are.

A direct message is for everything that is not about an identified patient: introducing yourself to a practice, asking what a colleague treats, checking whether they are taking new cases. Keep patient identifiers out of it.

If the practice you want to write to has not been sent a referral yet, that is the signal to send one rather than to describe the patient in a direct message. Sending the referral creates the conversation you need, with the consent gate and the access rules already applied.

A referral conversation is a practice-to-practice channel, not a private line between two people. On the sending side, colleagues at your practice can read it. On the receiving side, colleagues at the recipient practice can read it once that practice has been notified and the referral's consent is recorded. Your practice's visibility setting narrows this the same way it narrows the inbox: a clinician limited to their own referrals sees only the conversations on those referrals. See Inbox visibility: who on your team sees what.

A direct message is narrower. Only the two providers in the thread can open it, and a colleague at either practice cannot read it. Deactivating a member ends their access to both kinds of conversation.

Message bodies are encrypted at rest in both channels, and message and file activity is written to the audit log in both. The difference between them is scope and consent, not encryption.

Conversations in Messages are grouped by practice, so a practice you both refer to and message directly appears once with its threads underneath. Use Search practices... to narrow the list by practice or provider name, and the Referrals and DMs tabs to look in one channel at a time.

When a message arrives and you have not read it, Syncroly emails you a link that opens the thread. Messages have a 2,000 character limit, and the counter appears as you approach it.