Smartsheet vs Monday.com for HIPAA Compliance: What Small Practices Need to Know

Two Enterprise Tools, Two Different HIPAA Problems

Smartsheet and Monday.com take opposite approaches to HIPAA compliance, and both create problems for small medical practices.

Smartsheet’s problem is scope. The platform offers a BAA on its Enterprise plan, but excludes every significant add-on module. WorkApps, Resource Management, Brandfolder, Bridge, and Dynamic View are all outside BAA scope. For practices that adopted Smartsheet for these features, HIPAA compliance means giving up the tools they use most.

Monday.com’s problem is access. The 25-seat minimum for Enterprise prices out most small practices. A 10-person clinic must pay for 15 seats nobody uses, at $600–750/month minimum, before a single task involving PHI can be managed on the platform.

Both problems were created by enterprise software companies treating HIPAA as an enterprise upsell rather than a baseline capability.

Pricing Side-by-Side

Smartsheet Enterprise: Custom-quoted. Published ranges put it at $15,000–$250,000+/year depending on user count and features. A practice must go through a sales cycle to get a number. The core platform is covered by the BAA, but WorkApps, Resource Management, and other add-ons are not.

Monday.com Enterprise: Custom-quoted with a 25-seat minimum. At estimated $24–30/seat/month, a practice at the minimum floor spends approximately $600–750/month ($7,200–9,000/year) for 25 seats even if only 10 people use the platform.

PHIGuard Essentials: $99/month flat for up to 8 staff. All features covered. No sales call required to activate a BAA.

What HIPAA Mode Actually Disables

Smartsheet has no HIPAA mode toggle — manual configuration is required to keep PHI out of excluded modules. There is no UI-level enforcement preventing data from flowing into WorkApps or Resource Management; it depends on administrative discipline. This creates audit risk if staff use excluded modules without realizing they’re outside BAA scope.

Monday.com disables document preview in HIPAA mode. Staff cannot view shared files inline — every attachment must be downloaded to view. For workflows involving clinical documentation, this is a meaningful friction point. Monday.com’s inclusion of AI features in HIPAA scope is unusual and genuinely useful, but does not offset the access and cost problems for small practices.

PHIGuard has no HIPAA mode because every feature was designed to operate within HIPAA boundaries. There are no modules to exclude and no features to disable.

The Add-On Exclusion Problem in Practice

Smartsheet’s add-on exclusion issue deserves attention because it affects practices that evaluated Smartsheet for its full feature set.

A practice that signed up for Smartsheet because of WorkApps (building custom workflow applications on top of sheets) or Resource Management (staff scheduling and capacity planning) cannot use PHI in either module. The BAA covers the core Smartsheet grid and basic automations. Everything built on top of it — the features that justify enterprise pricing — is excluded.

This matters for a specific reason: auditors look at where PHI actually flows, not where it’s supposed to flow. If staff are building workflows in WorkApps because that’s where the interface lives, and those workflows touch patient names or appointment data, the excluded module is in scope for an OCR investigation regardless of what the contract says.

Who These Tools Actually Fit

Smartsheet fits large organizations — hospital systems, health networks — with dedicated IT staff to configure and audit compliance scope manually, and with negotiating leverage to get favorable enterprise terms. The $15,000+ price floor reflects that target customer.

Monday.com fits organizations with 25+ staff where the seat minimum isn’t a penalty, and where the visual board interface and automation engine justify enterprise pricing. It works for clinic groups, regional health networks, and large multi-site practices.

Neither tool fits a 3–20 person medical practice evaluating task management for the first time or switching from spreadsheets.

Verdict

Smartsheet has the broadest HIPAA scope problem — every major add-on is excluded from the BAA — but Monday.com's 25-seat minimum makes it inaccessible to most small practices. Neither platform considered healthcare administration when they built their compliance approach. PHIGuard was.