Is Google Sheets HIPAA Compliant?

Is Google Sheets HIPAA compliant? This is a crucial question for healthcare professionals and organizations managing sensitive patient data. As cloud-based tools like Google Sheets become more popular for collaboration and record-keeping, understanding their role in HIPAA compliance is more important than ever.

Many organizations wonder if they can safely store PHI in spreadsheets using Google Sheets, especially when dealing with electronic protected health information (ePHI). While Google Sheets offers efficiency and flexibility for managing healthcare data, there are strict requirements that must be met to ensure compliance with HIPAA regulations.

In this article, we’ll break down what it takes for Google Sheets to be used in a HIPAA-compliant way. We’ll cover topics like the need for a BAA with Google Workspace, setting up proper access controls, sharing settings, and the potential risks to be aware of when using Google Sheets for ePHI storage.

We'll also share practical steps and best practices for keeping your Google Sheets secure, highlight the tool’s limitations for handling sensitive data, and explore alternatives and user responsibilities. By the end, you’ll have a clear understanding of what’s required to use Google Sheets safely and compliantly in a healthcare setting.

Can Google Sheets Be HIPAA Compliant?

Can Google Sheets Be HIPAA Compliant? The answer depends on how we set up and use the platform within the requirements of HIPAA. While Google Sheets is not automatically compliant out of the box, it can support HIPAA compliance when integrated with Google Workspace HIPAA features and managed according to strict security protocols.

To enable HIPAA compliance, we must first have a signed BAA (Business Associate Agreement) with Google Workspace. This agreement is essential because it ensures Google takes on responsibility for safeguarding any healthcare data in Google Sheets that qualifies as ePHI (electronic Protected Health Information). Without this agreement, storing PHI in Google Sheets is not permitted under HIPAA regulations.

However, compliance goes further than paperwork. To create secure Google Sheets for PHI management, organizations must:

• Configure access controls so that only authorized team members can view or edit sensitive data.
• Enable encryption for data both at rest and in transit, which is offered by Google Workspace’s security infrastructure.
• Restrict sharing by disabling public links and carefully managing user permissions to prevent accidental exposure of PHI in spreadsheets.
• Implement audit trails—Google Workspace provides logging tools to track who accessed or modified documents, helping us monitor for unauthorized activity.
• Educate staff on the correct procedures for handling PHI and using security features in Google Sheets.

It’s important to remember that while Google provides the technical capability for HIPAA compliance, the responsibility for correct usage always rests with us. We must consistently enforce policies and provide ongoing training to avoid mistakes that could compromise ePHI storage in spreadsheets.

In summary, Google Sheets can be HIPAA compliant when used within Google Workspace under a BAA and combined with strong administrative, technical, and physical safeguards. By following best practices for secure configuration, access management, and ongoing monitoring, we can confidently use Google Sheets to store and manage sensitive healthcare data while meeting HIPAA’s rigorous standards.

Google Workspace BAA Requirement

Google Workspace BAA Requirement

If your organization plans to use Google Sheets for handling PHI in spreadsheets, you must secure a Business Associate Agreement (BAA) with Google Workspace. The BAA is the legal foundation that allows healthcare providers and their partners to use Google’s services for ePHI storage while maintaining HIPAA compliance. Without this agreement, using Google Sheets for any healthcare data—even with robust security settings—puts your organization at risk of serious compliance violations.

Here’s what you need to know about the BAA Google Workspace requirement:

• Eligibility: Only certain Google Workspace editions, such as Business Plus, Enterprise, and specific Workspace for Education accounts, are eligible for a BAA. Free consumer Google accounts are not covered.
• Activation: The BAA does not take effect automatically. Administrators must formally review and accept the BAA through the Google Workspace Admin console. If you haven’t completed this process, you are not HIPAA compliant, regardless of other security measures in place.
• Service Scope: Not every Google service is covered under the BAA. For example, core services like Google Sheets, Drive, and Gmail are included, but add-ons, third-party apps, and some advanced features might not be. Always verify which tools are covered before storing any healthcare data Google Sheets.
• Responsibility Split: The BAA outlines Google’s commitments regarding infrastructure security, but your organization is responsible for configuring access controls, managing user permissions, and ensuring that only authorized personnel work with PHI in Google Sheets.

Securing a BAA with Google Workspace is the first, non-negotiable step before storing or sharing any PHI in spreadsheets on Google Sheets. It’s essential to review the agreement with your compliance team so you fully understand both your obligations and Google’s. By following this requirement, we can confidently use secure Google Sheets as part of our healthcare data management workflow—while keeping patient privacy and regulatory compliance front and center.

Configuring Google Sheets for PHI (Access Controls

Configuring Google Sheets for PHI (Access Controls)

When handling healthcare data in Google Sheets, robust access controls are essential for HIPAA compliance. Setting up the right security measures ensures that only authorized users can access, edit, or share sensitive information, like PHI in spreadsheets. Let’s look at practical steps to configure access controls and keep your Google Sheets secure:

• Restrict document access: Limit who can open and edit your Google Sheets by inviting only specific users via their work email addresses. Avoid using public links or the "Anyone with the link" sharing option, as this exposes ePHI storage to unnecessary risk.
• Set appropriate permissions: Assign roles based on necessity. Give users "Viewer," "Commenter," or "Editor" access, depending on their job responsibilities. This aligns with the principle of least privilege, reducing the risk of accidental data exposure.
• Leverage Google Workspace admin controls: Use your organization’s Google Workspace HIPAA settings to enforce two-factor authentication, monitor user activity, and restrict sharing outside your organization. These admin tools add an extra layer of protection.
• Monitor access and sharing activity: Regularly review the sharing settings for your sensitive sheets. Google Workspace provides audit logs, allowing you to track who has accessed or modified healthcare data Google Sheets. If you spot unfamiliar access, investigate immediately.
• Disable download, copy, and print for viewers and commenters: When possible, restrict these actions in the sharing settings to prevent unauthorized distribution of PHI.

By proactively managing access controls and using the tools provided under your BAA with Google Workspace, you can significantly reduce the risk of unauthorized access or breaches. Remember, HIPAA compliance is a shared responsibility—configure your Google Sheets thoughtfully to keep your PHI in spreadsheets as secure as possible.

Sharing)

Sharing healthcare data in Google Sheets requires thoughtful security practices, especially when managing PHI in spreadsheets. Even with a BAA Google Workspace in place, improper sharing can jeopardize HIPAA compliance and patient privacy.

To maintain secure Google Sheets and safeguard ePHI storage, it's essential to control exactly who can access and interact with your documents. Here’s how we can share responsibly while meeting Google Workspace HIPAA requirements:

• Share only with authorized users: Limit access strictly to team members who need it. Avoid using public or company-wide sharing links for documents containing PHI.
• Use granular permissions: Assign the lowest level of access necessary—prefer "Viewer" or "Commenter" roles unless someone truly needs "Editor" rights.
• Disable link sharing: Prevent accidental exposure of sensitive information by turning off link sharing and never publishing healthcare data Google Sheets to the web.
• Monitor sharing activity: Regularly review the sharing settings and audit user access to quickly spot and correct any unauthorized sharing.
• Set expiration dates: For temporary access, use Google Workspace features to set expiration dates on shared links and user permissions, minimizing risk over time.
• Educate your team: Make sure everyone understands the risks of improper sharing and knows how to use sharing settings securely within the healthcare context.

By putting these best practices in place, we help ensure that healthcare data Google Sheets remain private, protected, and compliant with HIPAA—giving both organizations and patients peace of mind.

Risks of Using Google Sheets for ePHI

Risks of Using Google Sheets for ePHI

While Google Sheets, under a BAA with Google Workspace, can technically support HIPAA-compliant workflows, there are several critical risks associated with using it to store or share electronic protected health information (ePHI). Understanding these risks helps us make smarter decisions about safeguarding sensitive healthcare data in Google Sheets.

• Accidental Data Exposure: Sharing permissions in Google Sheets are powerful, but also easy to mismanage. A simple misclick or using “anyone with the link” can expose PHI in spreadsheets to unauthorized users, creating a major compliance risk.
• Audit and Monitoring Limitations: While Google Workspace provides some audit tools, tracking every view, share, or edit involving ePHI can be challenging. Limited audit trails make it harder to spot unauthorized access or suspicious activity.
• Data Retention and Deletion Challenges: Deleting sensitive healthcare data from Google Sheets isn’t always straightforward. Files may remain in trash folders, backups, or be duplicated elsewhere, complicating true ePHI disposal and increasing breach risk.
• Third-Party Add-ons and Integrations: Many organizations enhance their spreadsheets with add-ons for workflow or analytics. However, not all third-party tools are HIPAA compliant, and integrating them can unintentionally expose ePHI.
• Device and Endpoint Vulnerabilities: Google Sheets can be accessed from multiple devices. If a user’s laptop or mobile device is lost, stolen, or compromised, any stored access to secure Google Sheets could become a direct avenue to sensitive healthcare data.
• Human Error: Even with the best technical controls, human mistakes—such as downloading spreadsheets to insecure devices or pasting PHI into the wrong sheet—are a persistent risk.
• Inconsistent Security Practices: Not all users will follow best practices for password hygiene, multi-factor authentication, or secure sharing. These gaps can leave ePHI storage in Google Sheets vulnerable.

We all want to leverage the convenience and collaboration of Google Sheets, but it’s essential to recognize these risks. If your organization is considering Google Workspace for HIPAA needs, weigh these vulnerabilities carefully and implement strict protocols for secure Google Sheets usage. Always combine technical safeguards with strong user training to reduce the risk of an ePHI breach.

Best Practices for Secure Use

Best Practices for Secure Use

When handling healthcare data in Google Sheets, following proven best practices is essential to maintain HIPAA compliance and protect patient privacy. Here’s how we can keep our Google Sheets secure when storing or processing PHI in spreadsheets:

• Use Google Workspace with BAA: Always ensure your organization has a signed BAA with Google Workspace before storing any ePHI. The BAA defines security responsibilities and is required for HIPAA compliance.
• Restrict Access: Limit who can view or edit healthcare data in Google Sheets. Grant access only to authorized team members who absolutely need it. Regularly review and update permissions.
• Enable Advanced Security Features: Turn on two-factor authentication for all accounts with access to PHI. Use strong, unique passwords and enforce password rotation policies.
• Monitor Sharing Settings: Avoid using public or link-based sharing for sheets containing ePHI. Disable options to publish Google Sheets to the web or to anyone outside your organization.
• Set Up Audit Trails: Take advantage of Google Workspace’s activity logs. Regularly review logs for unusual access patterns or unauthorized attempts to access sensitive data.
• Employ Data Minimization: Only include the minimum necessary PHI in your spreadsheets. Avoid storing unnecessary identifiers or sensitive medical details unless absolutely required.
• Protect Data Integrity: Use cell and sheet protection features to prevent accidental edits or deletions. Lock down critical formula cells and sensitive information.
• Encrypt and Back Up Data: While Google encrypts data at rest and in transit, always verify encryption is enabled and up to date. Regularly back up data in a secure, HIPAA-compliant manner as an added layer of protection.
• Educate and Train Staff: Provide ongoing training about HIPAA, data privacy, and secure handling of PHI in Google Sheets. Make sure everyone knows what’s at stake and how to respond to incidents.
• Vet Third-Party Add-ons: Only use add-ons or integrations that are clearly HIPAA compliant. Evaluate vendors carefully, as third-party tools can introduce risks to your ePHI storage.

By putting these practices into action, we can leverage the power of Google Workspace HIPAA tools for collaboration while maintaining the strict confidentiality and security required for healthcare data in Google Sheets.

Limitations for Sensitive Data

Limitations for Sensitive Data

While Google Workspace offers robust security features and a BAA for HIPAA compliance, it's important to recognize that using Google Sheets for ePHI storage comes with significant limitations. Not all risks can be fully mitigated by technical controls or legal agreements. Here's what we need to keep in mind:

• Granular Access Restrictions: Google Sheets primarily rely on user-level access controls. Unlike traditional healthcare software, Sheets lack advanced role-based permissions, making it harder to tightly restrict access to only the minimum necessary data. This can increase the risk of unauthorized viewing or editing.
• Audit and Monitoring Limitations: While Google Workspace provides activity logs, the audit trails in Google Sheets are not as detailed as those found in dedicated healthcare data management systems. This can make it challenging to track every interaction with PHI in spreadsheets and to quickly respond to potential data incidents.
• Data Loss and Version Control: Collaborative editing is a powerful feature, but it also means that accidental deletions or overwrites can occur. Although version history helps, recovering from major errors can be complex—especially when dealing with sensitive healthcare data.
• Third-Party Add-ons and Integrations: Using add-ons or integrations not covered by your BAA with Google Workspace can introduce vulnerabilities. If these tools are not HIPAA-compliant, they may inadvertently expose or mishandle ePHI, undermining your security efforts.
• Unintentional Sharing Risks: Features like link sharing and publishing to the web are convenient, but they can result in accidental exposure of confidential information. Even brief periods of public access may constitute a HIPAA violation.
• Not a Replacement for EHRs: Google Sheets should not serve as a full-scale electronic health record (EHR) system. They lack critical features such as structured medical data fields, automated compliance checks, and comprehensive patient privacy safeguards.

In summary, while secure Google Sheets can support certain healthcare workflows under the right conditions, we must be cautious about the types and amount of healthcare data Google Sheets are used to store. Always evaluate whether the use of spreadsheets is appropriate for your organization’s specific HIPAA requirements and consider alternatives for managing highly sensitive information.

Alternatives to Google Sheets for PHI

Alternatives to Google Sheets for PHI

While Google Sheets can be part of a HIPAA-compliant workflow with the right controls and a BAA from Google Workspace, some healthcare organizations may prefer specialized solutions designed specifically for ePHI storage and management. Exploring alternatives ensures you’re not only protecting healthcare data in spreadsheets but also simplifying compliance efforts.

• HIPAA-Compliant Cloud Storage Platforms: Services like Microsoft 365 (Excel Online with a signed BAA), Box for Healthcare, and Dropbox Business for Healthcare offer advanced security features and clear compliance documentation. These platforms provide granular access controls, robust auditing, and encryption tailored for secure ePHI storage.
• Dedicated Healthcare Data Management Tools: Platforms such as athenahealth, Epic, and Cerner offer end-to-end solutions for managing PHI. These systems are purpose-built for healthcare workflows, with compliance controls integrated by default, minimizing the risk of accidental data exposure and simplifying the management of PHI in spreadsheets.
• Encrypted Spreadsheet Applications: Some vendors offer spreadsheet tools designed from the ground up for compliance, like Sheetgo or Smartsheet for Healthcare. These tools often include added layers of encryption, more customizable permissions, and detailed activity logs for tracking access to sensitive data.
• Custom HIPAA-Compliant Databases: For organizations with unique needs, developing a custom database solution on platforms like Amazon Web Services (AWS) or Google Cloud Platform (with a BAA in place) can provide tailored security and compliance. This approach is ideal when standard spreadsheet tools cannot meet workflow or security requirements.

When evaluating alternatives to Google Sheets for healthcare data, prioritize solutions that offer robust audit trails, encryption, fine-grained access controls, and clear support for HIPAA compliance. Always ensure a BAA is in place with any cloud provider handling PHI. By choosing a tool purpose-built for secure Google Sheets alternatives, you can better protect patient privacy and reduce compliance headaches.

User Responsibilities for Compliance

User Responsibilities for Compliance

While Google Workspace HIPAA features and a signed BAA Google Workspace agreement provide a strong foundation, the ultimate responsibility for compliance with HIPAA rests with users and administrators. When handling PHI in spreadsheets or other healthcare data Google Sheets, one misstep can lead to costly violations. Here’s what you need to focus on to ensure your use of Google Sheets stays secure and compliant:

• Access Control: Assign access only to those who truly need it. Regularly review sharing settings and remove users who no longer require access to PHI. For secure Google Sheets, avoid public sharing links and restrict document access to specific individuals within your organization.
• Audit and Monitor Activity: Routinely check document activity logs for unusual access patterns or unauthorized changes. Monitoring user actions helps you quickly detect and respond to any potential breach involving ePHI storage.
• Data Handling Best Practices: Only input the minimum necessary PHI into spreadsheets. Never use Google Sheets for unnecessary or excessive storage of sensitive healthcare data. Always double-check before pasting or uploading any information.
• Device and Session Security: Ensure that all devices used to access Google Sheets are protected by strong passwords, antivirus software, and are regularly updated. Log out of accounts when not in use, especially on shared or public devices.
• Ongoing Training: Provide continuous HIPAA training for all staff who interact with healthcare data on Google Sheets. Make sure everyone understands the latest threats and proper protocols for ePHI storage and sharing.
• Incident Response: Establish clear procedures for reporting, investigating, and mitigating any suspected or confirmed breaches. Quick action can limit damage and demonstrate compliance diligence if an incident occurs.

By actively managing these responsibilities, we can use Google Sheets as a powerful tool for collaboration and data management, without compromising the privacy and security of sensitive healthcare information. Remember, compliance isn’t a one-time setup—it’s an ongoing commitment to protecting your patients and your organization.

Data Encryption and Google Sheets

Data Encryption and Google Sheets plays a pivotal role in protecting healthcare data stored and shared within Google Workspace. When we’re handling ePHI storage or managing PHI in spreadsheets, encryption ensures that sensitive information remains confidential and inaccessible to unauthorized individuals.

Google Workspace, which includes Google Sheets, uses robust encryption protocols to secure data both at rest (when stored on Google's servers) and in transit (when moving between your devices and Google’s infrastructure). This means that when you upload or edit healthcare data in Google Sheets, the platform automatically encrypts your information using industry-standard protocols such as TLS and AES-256.

However, encryption alone isn’t a guarantee of HIPAA compliance. To leverage these encryption features as part of a secure Google Sheets workflow, you must:

• Enable encryption by default: Google Workspace automatically encrypts all data, but double-check your admin settings to make sure encryption is active for your domain.
• Sign a BAA with Google: Only after executing a BAA Google Workspace agreement does Google formally commit to safeguarding your healthcare data, including the encrypted data in Google Sheets.
• Utilize access controls: Encryption is powerful, but it must be paired with strict access management to ensure only authorized personnel can view or modify healthcare data Google Sheets files.
• Educate your team: Even encrypted data can be compromised through human error. Train your staff to recognize phishing attempts and avoid sharing credentials or sensitive links.

For organizations that require additional security, third-party tools can provide client-side encryption, adding another layer of protection before any data is uploaded to Google Sheets. Just remember, any solution you use must also be HIPAA compliant.

In summary, while Google Sheets within Google Workspace offers strong encryption for ePHI storage, effective HIPAA compliance is a shared responsibility. We must combine Google’s built-in security with organizational best practices, a signed BAA, and vigilant user education to genuinely protect healthcare data in the cloud.

Audit Trails and Monitoring Capabilities

Audit Trails and Monitoring Capabilities are essential when handling healthcare data in Google Sheets under HIPAA regulations. Audit trails provide a transparent record of who accessed, edited, or shared sensitive information, which is critical for both accountability and identifying potential security incidents involving PHI in spreadsheets.

Within the Google Workspace HIPAA environment, Google Sheets offers several native features to support monitoring and auditing activities:

• Version History: Google Sheets automatically tracks every change made to a document. You can review previous versions, see who made each edit, and restore earlier versions if needed. This is vital for maintaining the integrity of ePHI storage and quickly identifying unauthorized changes.
• Activity Dashboard: The activity dashboard in Google Sheets allows you to view who has accessed the file and when. This helps administrators monitor for unusual access patterns or unauthorized viewing of sensitive healthcare data Google Sheets contains.
• Admin Audit Logs: With BAA Google Workspace in place, administrators can access comprehensive audit logs through the Google Admin console. These logs capture user activity across the organization, including logins, sharing events, and file access, providing a broad overview of data interactions.

To maximize these monitoring capabilities for secure Google Sheets usage, we recommend the following best practices:

• Regularly review version histories and activity dashboards for all sheets containing PHI.
• Set up alerts for suspicious activity or unauthorized access attempts.
• Restrict audit log access to authorized personnel only, maintaining an additional layer of privacy and security.
• Document and investigate any anomalies to ensure prompt response to potential breaches.

By actively leveraging these audit and monitoring features, we can maintain a robust compliance posture. These steps not only support HIPAA requirements but also build trust in how we manage and protect sensitive healthcare data in Google Sheets.

Is Google Sheets HIPAA compliant? The answer depends on how you use it. With the right precautions, including securing a BAA for Google Workspace, Google Sheets can be part of a HIPAA-compliant workflow. However, compliance isn’t automatic—organizations must actively manage access, enable security features, and closely monitor how PHI in spreadsheets is handled.

Storing healthcare data in Google Sheets can be convenient, but we must treat it with the same care as any other ePHI storage solution. Using secure Google Sheets practices—like limiting user permissions, encrypting data, and regularly auditing activity—can help protect sensitive information and minimize risk.

Ultimately, Google Workspace offers the tools needed to support HIPAA compliance when managing patient data. It’s our responsibility to maintain strong security habits, review compliance measures regularly, and ensure all team members understand their roles in protecting healthcare data in Google Sheets. With a proactive approach, we can confidently leverage the power of Google Sheets while keeping patient privacy at the forefront.

FAQs

Is Google Sheets HIPAA compliant by default?

No, Google Sheets is not HIPAA compliant by default. While Google Sheets is a powerful and convenient tool for managing data, using it for healthcare data in Google Sheets—especially if it involves ePHI storage or PHI in spreadsheets—requires additional safeguards beyond the standard settings.

To use Google Sheets in a HIPAA-compliant way, you need to have a Business Associate Agreement (BAA) with Google Workspace. Without a BAA in place, storing or sharing PHI with Google Sheets is not permitted under HIPAA regulations. The default setup lacks the necessary legal and security assurances to protect sensitive healthcare information.

Even after securing a BAA, it's crucial to configure access controls, enable encryption, and follow best practices for secure Google Sheets usage. This helps ensure patient privacy and maintains compliance with HIPAA standards for any Google Workspace HIPAA environment.

Do I need a BAA to use Google Sheets for PHI?

Yes, you absolutely need a Business Associate Agreement (BAA) to use Google Sheets for storing or processing Protected Health Information (PHI). Under HIPAA regulations, any healthcare data stored in cloud services like Google Sheets is considered electronic PHI (ePHI) and must be protected accordingly.

Google Workspace HIPAA compliance depends on having a signed BAA between your organization and Google. Without this agreement, using Google Sheets to manage PHI in spreadsheets is not compliant, regardless of any security features you enable. The BAA outlines Google’s responsibilities to safeguard healthcare data and ensures your use of Google Sheets meets legal standards.

Even with a BAA in place, it’s up to you to configure secure Google Sheets practices—such as strict access controls, audit logging, and encryption—to keep patient data safe. So, if your organization handles ePHI storage or healthcare data in Google Sheets, obtaining a BAA through Google Workspace is a mandatory first step for HIPAA compliance.

How can I secure PHI in Google Sheets?

Securing PHI in Google Sheets starts with the essentials: First, ensure you’re using Google Workspace with a signed Business Associate Agreement (BAA) from Google. This agreement is necessary for HIPAA compliance and ensures Google is also accountable for protecting healthcare data within Google Sheets.

Limit access to PHI in spreadsheets by sharing documents only with authorized team members. Use Google Workspace’s advanced sharing settings to restrict who can view or edit each sheet. Always enable two-factor authentication for all users to add an extra layer of security.

Protect ePHI storage and transmission by taking advantage of built-in encryption in Google Workspace. Data is encrypted both at rest and in transit, but it’s vital to avoid sharing links publicly or publishing sheets to the web. Regularly audit access logs to quickly identify any unauthorized activity.

Educate your team on HIPAA best practices for handling healthcare data in Google Sheets. Train staff to recognize potential risks, use secure sharing options, and never store more sensitive information than absolutely necessary. Staying proactive and vigilant is the best way to keep PHI secure in your spreadsheets.

What are the risks of using Google Sheets for PHI?

Using Google Sheets for PHI (Protected Health Information) comes with specific risks that healthcare organizations must carefully manage. The main concern is that without proper safeguards, sensitive patient data can be exposed to unauthorized access, both internally and externally. This risk increases if sharing settings are too broad, or if links are accidentally shared outside the intended group.

Another key risk is related to compliance with HIPAA regulations. If your organization does not have a signed Business Associate Agreement (BAA) with Google Workspace, using Google Sheets to store or process healthcare data is not permitted under HIPAA. Even with a BAA, it’s crucial to implement strict access controls and monitoring to ensure only authorized users handle ePHI.

Security vulnerabilities can also arise from improper user management or weak authentication. If two-factor authentication is not enabled, or if users reuse passwords, attackers may gain unauthorized access to PHI in spreadsheets. Additionally, third-party add-ons or integrations that aren’t HIPAA-compliant can create further security gaps.

Finally, accidental data sharing or mismanagement is a real risk in collaborative environments like Google Sheets. Users may inadvertently expose healthcare data through public links or incorrect permissions, leading to potential HIPAA violations and data breaches. To safeguard ePHI storage, always review sharing settings, provide user training, and regularly audit access to your secure Google Sheets.