Best Smartsheet HIPAA Alternative for Healthcare Teams

Why Healthcare Teams Look at Smartsheet

Smartsheet occupies a specific niche: it looks like a familiar spreadsheet but behaves like a project management platform. Practice managers comfortable with Excel who want more structure without switching to unfamiliar software put it on shortlists.

At the enterprise level, it has genuine compliance capabilities. The compliance capabilities are locked behind pricing most small practices can’t access, and the add-on exclusions create a wider gap than most buyers realize before signing.

Enterprise-Only Pricing, With No Lower-Cost HIPAA Path

Smartsheet’s free, Pro ($9/user/month), and Business ($19/user/month) tiers do not offer a BAA. The only HIPAA-eligible path is Enterprise, custom-quoted.

For a 10-person medical practice, Enterprise-tier pricing for task management is not a reasonable use of operating budget. The tool being evaluated is a spreadsheet with project features, not a clinical workflow platform.

The Broadest Add-On Exclusion in the Category

Every major project management vendor excludes some features from their BAA. Smartsheet’s exclusion list is the widest in the category.

The following Smartsheet products are explicitly excluded from the BAA scope:

• WorkApps — Smartsheet’s low-code application builder
• Resource Management (formerly 10,000ft) — capacity and staffing planning
• Brandfolder — digital asset management
• Bridge — Smartsheet’s workflow automation platform
• Dynamic View — role-based data access tool

A healthcare organization that adopts Smartsheet Enterprise and builds workflows in Bridge or WorkApps has no HIPAA coverage for those workflows, even with an active Enterprise contract and signed BAA.

No HIPAA Mode — Customer Manages Configuration

Smartsheet does not offer an automated HIPAA compliance toggle. Enterprise customers receive access to security and audit features but must configure them manually following Smartsheet’s implementation guide:

• Audit logs must be enabled and reviewed
• Access controls must be configured per the implementation guide
• Data retention settings must be set correctly
• User provisioning must follow Smartsheet’s recommended practices

Misconfiguration is the customer’s compliance liability. This places real technical responsibility on practices that typically don’t have dedicated IT staff.

How PHIGuard Compares

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PHIGuard starts at $99/month flat. The BAA is included at every tier. There are no add-on exclusions because PHIGuard’s compliance is built into the core product, not layered on through configuration or limited to a subset of features.

The Enforcement Context

In 2024, OCR collected $9.9 million across 22 enforcement actions — and inadequate risk analysis was the most frequently cited violation. Median fines run $20,000–$35,000.

A practice using Smartsheet Business because Enterprise pricing is out of reach has full regulatory exposure. Enforcement doesn’t scale down based on practice size.

Who Should Stay on Smartsheet

Smartsheet Enterprise is appropriate for large health systems with existing Smartsheet deployments, IT staff to manage configuration, legal counsel to review the add-on exclusions, and budgets that can absorb the Enterprise contract. Portfolio management, resource planning, and multi-department coordination at scale are legitimate use cases.

For small practices, the pricing floor, configuration burden, and add-on exclusion scope make it a poor fit. PHIGuard handles clinical task management at a fraction of the cost with no configuration required.