> ## Documentation Index
> Fetch the complete documentation index at: https://docs.decodahealth.com/llms.txt
> Use this file to discover all available pages before exploring further.
# Blasts
> Send bulk email and SMS messages to groups of patients using cohorts.
**Where to find Blasts:** In the left sidebar, click **Comms > Blasts**.
**Prerequisites:** You need [Patients](/modules/patients) in the system before
sending blasts. You also need at least one [Cohort](/modules/comms/cohorts) to
define your audience. For email blasts, your organization must have a verified
sending domain configured in [Email Settings](/modules/settings/emails).
Blasts let you send bulk messages -- either email or SMS -- to a group of patients at once. You define the audience using **cohorts** (saved patient filters), compose your message, and send. The system tracks delivery, engagement, and unsubscribes automatically.
## Key Concepts
* **Blast** -- A single bulk send. Each blast targets one or more cohorts and sends via either email or SMS.
* **[Cohort](/modules/comms/cohorts)** -- A saved group of patients defined by filters (location, provider, tags, etc.). Cohorts are reusable across multiple blasts.
* **Marketing vs. Transactional** -- Marketing blasts (promotions, newsletters) require patient opt-in and include an unsubscribe link. Transactional blasts (appointment reminders, billing notices) are sent regardless of marketing opt-in but still respect hard blocks like suppression and STOP requests.
## Send an SMS Blast
Go to **Comms > Blasts** and click **New Blast**. Give your blast a name (or leave it blank to auto-generate one). Select one or more cohorts to define your audience, then choose **SMS** as the channel.
Click **Next: Compose** to continue.
Type your message in the text editor. As you type, the character count and text count update below the editor so you can keep messages concise.
You can personalize each message by inserting details about the patient or your organization. Type **@** in the editor to see available options like first name, last name, and your organization's name. Each patient receives a version of your message with the relevant details filled in automatically.
To attach images (sent as MMS), click **Attach Images**. You can attach up to 3 image files (JPG, PNG, or GIF), each under 1 MB. Note that MMS messages cost roughly 3x more than standard SMS.
Check the **Marketing message** box if your blast is promotional (deals, newsletters, re-engagement campaigns). Marketing blasts will only be sent to patients who have opted in to SMS marketing. Leave it unchecked for transactional messages like appointment reminders or billing notices.
The panel on the right shows a breakdown of your audience:
* **Will send** -- Patients who will receive the message.
* **Opted out** -- Patients who have opted out of SMS (via STOP or clinic settings). These patients are skipped.
* **No contact info** -- Patients without a phone number on file.
* **Landline** -- Patients whose number is marked as a landline.
* **Not opted in** -- Patients who haven't opted in to SMS marketing (only shown for marketing blasts).
Click **Preview Recipients** to see the full list of patients and their individual status.
A cost estimate appears below the preview based on message length and recipient count.
Click **Send Test to Me** to send a test message to your own phone number. This lets you check how the message looks before sending it to patients.
Click **Send Blast**. Messages are sent individually to each patient's phone number. You'll be redirected to the blast detail page where you can monitor delivery progress.
## Send an Email Blast
Go to **Comms > Blasts** and click **New Blast**. Give your blast a name, select one or more cohorts, and choose **Email** as the channel.
Click **Next: Compose** to continue.
The **From** field shows who the email appears to come from. By default this is your practice name. To change it, type a different name in the From field. This is what patients see as the sender in their inbox.
Your selected cohorts appear in the **To** field. You can add or remove cohorts using the **+ Cohort** button.
Type your subject line in the **Subject** field. This is what patients see in their inbox. You can also add **Preview Text** -- the short snippet that appears next to the subject line in most email apps.
Use the email editor to build your message. The editor is organized into rows -- each row is a section of your email that you can move around and edit independently.
**Editing content:**
* Click on a row to select it (a blue outline appears around it).
* Double-click a row to start editing the text inside it.
* While editing, use the toolbar to format text -- bold, italic, underline, headings, lists, links, and alignment.
**Changing the font:**
* Select the text you want to change, then click the **Aa** button in the toolbar to open the font picker.
* Search for a font by name or scroll through the list. The picker includes common web-safe fonts and a selection of Google Fonts.
* Click a font to apply it to the selected text. If no text is selected, the font applies to whatever you type next.
**Adding new content:**
* Type **/** while editing to see a menu of content types you can insert: paragraphs, headings, images, buttons, blockquotes, and lists.
* Press **Enter** on an empty line to add a new row below.
**Adding a link to an image:**
* Click the image, then click **Link** to add the web address patients should open when they click it.
* You can also enter the web address in the image **URL** field in the style panel.
* To remove the link, click **Link**, then click **Remove**. The image stays in the email, but it is no longer clickable.
**Rearranging content:**
* Click a row to select it, then drag it up or down to reorder your email layout.
**Personalizing the email:**
* Type **@** to insert details like the patient's first name or your organization's name. Each recipient gets a customized version.
Switch to **HTML** mode if you prefer to write raw HTML directly. In HTML mode, click **Insert Image** to add one or more images where your cursor is. Use the **Highlight & scroll** switch to link the HTML box and preview while you review longer templates.
To attach files, click **Attach Files**. You can attach up to 10 files, each under 25 MB.
Open the style settings panel to customize:
* Font family and size
* Text color
* Button colors (background and text)
* Container background color
* Content width
Check the **Marketing message** box for promotional emails. Marketing emails automatically include an unsubscribe link in the footer and are only sent to patients who have opted in to email marketing. Leave it unchecked for transactional emails.
Review the send preview on the right panel, which shows:
* **Will send** -- Patients who will receive the email.
* **Suppressed** -- Patients whose email previously bounced or received a spam complaint. These patients are skipped.
* **Unsubscribed** -- Patients who have unsubscribed from marketing emails (only shown for marketing blasts).
* **No email** -- Patients without an email address on file.
* **Not opted in** -- Patients who haven't opted in to email marketing (only shown for marketing blasts).
Click **Send anyway** only if you want this marketing email blast to include patients listed under **Not opted in**. That choice stays with the blast for later warming batches, retries, and added recipients.
Click **Preview Recipients** to see the full list.
Click **Test Send** to send a test copy of the email to your own email address. Check your inbox to verify the layout, images, and links look correct.
Click **Send**. A confirmation window appears showing the recipient breakdown and estimated cost. Click **Send** to confirm. You'll be redirected to the blast detail page to monitor progress.
## Use AI to Write Your Message
Both SMS and email blasts include an AI writing assistant that can draft or refine your content.
**For SMS:** Click the AI icon in the message toolbar. Type a prompt describing what you want (e.g., "Remind patients about our holiday hours") and click **Generate**. Review the generated text, then click **Accept** to use it or provide feedback to regenerate.
**For email:** The AI can help with three parts of your email:
* **Subject line** -- Click the lightning icon next to the Subject field.
* **Preview text** -- Click the lightning icon next to the Preview Text field.
* **Email body** -- Use the AI bar in the editor. Type a prompt and click **Generate**.
After the first generation, you can refine the result by typing feedback (e.g., "Make it shorter" or "Add a call to action") and clicking **Regenerate**.
## Personalizing Your Message
You can include details about the patient or your organization in your message so each recipient gets a personalized version. Type **@** in the editor to see and insert available options.
| What you insert | What the patient sees |
| ----------------- | ------------------------------------------------------ |
| First name | Patient's first name |
| Last name | Patient's last name |
| Full name | Patient's full name |
| Preferred name | Patient's preferred name (falls back to first name) |
| Date of birth | Patient's date of birth (e.g., January 15, 1990) |
| Birthday | Patient's birthday without the year (e.g., January 15) |
| Phone number | Patient's phone number |
| Email | Patient's email address |
| Patient ID | Patient's ID |
| Organization name | Your organization's name |
## Viewing Blast Results
After sending, the blast detail page shows everything about that blast.
### Delivery Summary
A row of stat cards at the top shows the delivery breakdown at a glance. Click any card to filter the message list below to just those recipients.
**Email blast stats:**
* **Total** -- Total recipients in the blast.
* **Sent** -- Emails successfully handed off for delivery.
* **Skipped** -- Recipients skipped due to missing email, suppression, or being unsubscribed.
* **Opened** -- Recipients who opened the email, with the open rate percentage.
* **Clicked** -- Recipients who clicked a link, with the click rate percentage.
* **Failed** -- Emails that failed to deliver.
* **Bounced** -- Emails that bounced after delivery (e.g., invalid address, full mailbox).
**SMS blast stats:**
* **Total** -- Total recipients in the blast.
* **Sent** -- Messages successfully sent.
* **Skipped** -- Recipients with no phone number or a landline number.
* **Opted Out** -- Recipients who have opted out of SMS (e.g., by texting STOP).
* **Blocked** -- Recipients whose SMS has been disabled by the clinic.
* **Replied** -- Recipients who replied to the message.
* **Failed** -- Messages that failed to send.
### Skipped Breakdown
If any recipients were skipped, a **Skipped Breakdown** panel appears below the delivery summary. A stacked bar shows the share of skips by reason, with a pill for each reason (e.g., **No Email**, **Suppressed**, **Not Opted In**, **Unsubscribed**, **Landline**, **Opted Out**, **Blocked**, **Duplicate**) and its count. Click a pill to filter the message list below to just those recipients; click again to clear the filter.
### Engagement Chart (Email Only)
For completed email blasts, a chart shows cumulative opens and clicks over time so you can see how engagement builds in the hours after sending. Opens and clicks that arrive within a few seconds of delivery are treated as automated activity (link previewers, security scanners) and excluded from the open and click counts, so the numbers reflect real recipients.
### Message List
Below the summary, a table lists every recipient with their individual status, delivery timestamp, and engagement data (opens, clicks for email; replies for SMS). Use the stat cards above to filter this list.
### Low Delivery Alert
If fewer than 90% of messages were sent successfully, a warning banner appears at the top of the detail page showing the delivery rate and suggesting you review the failed messages.
## Stopping a Blast
You can stop a blast while it is still sending. On the blast detail page, click **Stop Blast**. The system stops within a few seconds. Messages already sent are not affected -- only unsent recipients are skipped.
A manually stopped blast shows a **Manually stopped** label on the detail page.
### Automatic Bounce Protection (Email Only)
For email blasts, the system monitors the bounce rate as messages are sent. If 8% or more of emails bounce after at least 500 have been sent, the blast is automatically stopped to protect your sending domain reputation. When this happens:
* The blast detail page shows the bounce rate that triggered the stop.
* A notification is sent to your team's alerts channel.
* You can review the bounced recipients, fix any issues, and use **Retry Failed** to resend.
## After Sending
### Retry Failed Messages
If some messages failed to deliver, click **Retry Failed** on the blast detail page. The system resends only the messages that failed -- it does not re-send to patients who already received the message.
### Add More Recipients
To send the same blast to additional patients after it has been sent:
1. Click **Add Recipients** on the blast detail page.
2. Search for patients and add them to the list.
3. Click **Send to \[X] patient(s)**.
The system skips anyone who already received this blast, so you won't send duplicates.
### Duplicate a Blast
To reuse a previous blast's content and settings:
1. Go to **Comms > Blasts**.
2. Click **Duplicate** next to the blast you want to copy.
3. The new blast form opens pre-filled with the original blast's content, cohorts, and settings.
4. Make any changes and send.
Duplicating an email blast also copies whether you chose **Send anyway** for patients who were not opted in to email marketing.
## Marketing vs. Transactional
The **Marketing message** checkbox controls how the system handles opt-in and unsubscribe rules.
| | Marketing | Transactional |
| ------------------------------- | -------------------------------------------- | ------------------------------------ |
| **Who receives it** | Only patients who have opted in to marketing | All patients with valid contact info |
| **Unsubscribe link (email)** | Automatically added to footer | Not included |
| **Opt-in required** | Yes | No |
| **Respects STOP / suppression** | Yes | Yes |
**When to use marketing:** Promotions, newsletters, re-engagement campaigns, seasonal offers.
**When to use transactional:** Appointment reminders, billing notices, policy updates, lab results.
Sending promotional content as a transactional message violates email and SMS
regulations. If your blast is promotional, always mark it as marketing.
## Unsubscribe Behavior
Marketing email blasts automatically include an unsubscribe link in the footer. When a patient clicks it:
1. Their email is marked as unsubscribed.
2. Their patient record is updated to opt out of email marketing.
3. Future marketing blasts skip them automatically.
Transactional blasts are not affected by unsubscribe status.
For SMS, patients can text **STOP** to your clinic's number to opt out of all SMS. They can text **START** to opt back in.
## Cost Estimates
The system shows an estimated cost before you send:
* **SMS:** Cost depends on message length (number of texts) and whether images are attached (MMS). The estimate updates in real-time as you type.
* **Email:** Cost is calculated per recipient.
After sending, the actual cost appears on the blast detail page.
## Analytics Dashboard
The **Blast Analytics** dashboard (open **Analytics** and pick **Blast Analytics** from the dashboard menu) shows aggregate trends and per-blast performance side by side.
**Filters:** narrow to specific blasts by **Blast name**, by **Medium** (Marketing or Transactional), or by **Type** (Email or SMS).
**Trends:** stacked charts show volume, spend, and email engagement (open and click rates) over the selected date range. Days with no engagement drop out of the engagement chart so trend lines aren't dragged down by empty days.
**Per-blast table:** every blast in the range appears as a row with **Revenue**, **Appointments** booked, **Spend**, and a **Total** row at the bottom. Click a blast to open its detail page. Group the table by **Medium** or **Type** to compare marketing vs. transactional, or email vs. SMS, at a glance.
## Common Questions
Recipients are skipped when they can't receive the message. Common reasons:
* **No contact info** -- The patient doesn't have a phone number (SMS) or email address (email) on file.
* **Opted out** -- The patient opted out of SMS (e.g., by texting STOP).
* **Blocked** -- The clinic disabled SMS to this patient.
* **Suppressed** -- The patient's email previously bounced or received a spam complaint. The system stops sending to suppressed emails to protect your sending reputation.
* **Unsubscribed** -- The patient clicked the unsubscribe link in a previous marketing email.
* **Not opted in** -- The blast is marked as marketing, but the patient hasn't opted in to receive marketing messages.
* **Landline** -- The patient's phone number is marked as a landline, which can't receive SMS.
Not currently. All blasts are sent immediately when you click Send.
Each blast is a separate send. If you want to resend to the same audience, duplicate the blast. The system does not prevent sending to patients who received a previous blast.
Email blasts require a verified sending domain. Marketing emails need a marketing domain and transactional emails need a transactional domain, both with valid DMARC records. Go to **Settings > Emails** to configure your domain.
The system tracks email opens and clicks for 72 hours after the blast is sent.
Blasts are designed to work with cohorts. If you need to message a small group of specific patients, create a cohort with the appropriate filters, then send the blast to that cohort.
**Failed** means the system attempted to send the message but it didn't go through (e.g., carrier error, email bounce). You can retry failed messages. **Skipped** means the system intentionally did not attempt to send because the recipient was ineligible (opted out, no contact info, etc.).
A blast can be stopped in two ways: you clicked **Stop Blast**, or the system automatically stopped it because too many emails were bouncing. In either case, messages already sent are delivered normally. Unsent recipients were not contacted. You can use **Retry Failed** to resend any messages that failed before the blast was stopped.
A large email blast from a new sending domain is sent in daily batches to protect your domain's reputation with mailbox providers. This is called **email warming** and it's automatic. See [Email Warming](/modules/comms/email-warming) for how daily caps work, how to read the send schedule, and when your domain graduates to unlimited sending.