Security in behavioral health doesn’t start with buying more tools. It starts with knowing what you already have. As Xpio Health CEO Thaddeus Dickson puts it, “knowing who has access, knowing why they have it, and making sure they lose it when they no longer need it” is the starting line for digital security.
That’s a clear strategic truth. But in the real world of competing priorities and limited resources, how do you turn that principle into action?
This post offers a practical roadmap. If you’re a program or IT manager responsible for access, security, or compliance, this is for you. We’ll walk through how to gain visibility into who has access to what, and what you can do about it right now.
Start by Knowing Where Access Lives
You can’t manage access if you don’t know where your users are logging in. Most behavioral health agencies have more systems than they realize. Yes, the EHR is central, but access often extends to learning platforms, payer portals, productivity tools, and a dozen applications used by specific departments.
Start broad. Talk to your HR team, IT staff, and program leaders. Ask a simple question: What systems do your people need to log into to do their jobs?
Build a single list. Capture the name of each system, what it’s used for, and which team owns it. Even a spreadsheet works. This becomes your working map.
Most agencies find surprises here. A forgotten survey tool with patient info. A shared file drive with no access tracking. Or a legacy scheduling app still used by one department.
Then Audit Who Has Access
Once you have the systems mapped, the next step is to see who’s inside. Pull user lists from each system. Compare them to your official HR roster of active staff and contractors.
This takes some legwork, especially for older systems or vendor-hosted tools. But the payoff is immediate. You’ll likely uncover accounts that belong to former employees. You might find staff with access to systems they haven’t used in months. Or roles with privileges far beyond what’s needed.
Start with high-impact systems first. Focus on anything that contains Protected Health Information or financial data. Don’t try to clean everything up at once. Even resolving a few high-risk mismatches significantly lowers exposure.
Fix the Lifecycle Before It Creates More Problems
Access issues often start with the basics. Someone starts a new role, but no one tells IT. Someone leaves, but their email stays live. The fixes are simple, but they require coordination.
You don’t need complex software to get this right. What you do need is a defined process for onboarding, offboarding, and internal transfers.
When someone joins the organization, there should be a clear trigger for requesting the access they need. Not more, not less. When someone leaves, there should be a checklist to remove them from every system they touched. Role changes should follow the same structure. Don’t assume people only gain access. Make sure they lose the old stuff too.
Treat these processes like part of your security posture. Because they are.
Control Access Creep Before It Spreads
Over time, people accumulate access they no longer need. Maybe they moved teams. Maybe they filled in for someone once and never lost the permissions. This “access creep” creates risk that often goes unnoticed.
The principle of least privilege helps solve this. That means giving people just enough access to do their job, and no more.
This doesn’t have to be complicated. Start with your highest-risk systems and look at who has admin access. Are all those people still in admin-level roles? Are any of them contractors or part-time staff?
Then, work with managers to define what’s really needed for key positions. Revisit these periodically. Especially when people change roles or your tech stack shifts.
Plan for Automation, But Start with Process
Manual visibility isn’t scalable forever, but it’s where you start. Over time, as your processes mature, you can look to automation. Tools that integrate with your HR system can help create and remove accounts automatically. Some can even centralize access reviews and help prepare for audits like HIPAA or SOC 2.
But don’t wait for the perfect platform to take action. Visibility is about discipline, not software. A strong spreadsheet and a consistent process will take you a long way.
That said, as your agency grows, these manual efforts can build a case for investing in Identity and Access Management or compliance automation tools. You’ll have the data to back it up and the experience to use those tools wisely.
Visibility Is a Security Practice
User access visibility isn’t a one-time project. It’s a culture shift. The goal isn’t to punish or police. It’s to create clarity, reduce risk, and protect the work your team is doing every day.
It’s also an achievable goal. One department, one system, one process at a time. If the landscape feels overwhelming, that’s okay. Xpio Health works with behavioral health agencies every day to bring order to messy access environments.
What’s the one system in your organization you wish you had better visibility into? Let’s explore how to make that happen. Contact Xpio Health for a free consultation.
#BehavioralHealth #CyberSecurity #UserAccessManagement #PeopleFirst #XpioHealth
