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Health Data Residency: EU by Default, Optional US Cluster
Here's our guide to which region your users' health data is processed and stored in, why we default to the EU, and when it makes sense to add a US cluster.
Health data is the kind of data lawyers ask about first. Before anyone at a customer looks at our API, someone in legal or security wants to know where the data sits, who can reach it, and whether it ever crosses a border. Fair enough. Here are the answers.
Where the health data lives
By default, every user's health data lives in Terra's EU cluster. That's true for your EU users, your UK users, and your US users. You don't configure anything. You onboard to Terra and the data is processed and stored in Europe.
Data never leaves its cluster, and nothing quietly copies it somewhere else.
Does HIPAA require US health data to stay in the US?
No. US law does not generally require health data to be stored on US soil, and that includes HIPAA. HIPAA is about how you protect the data and who can access it, not which country the disks are in. A US company can run its users' health data through our EU infrastructure, and we sign a HIPAA BAA either way.
The exception is when something other than HIPAA says otherwise. Some enterprise agreements, procurement rules, or regulators specify that data stays in the US. If yours does, we set up a US cluster for you. If it doesn't, EU-only is simpler, and it's what we recommend starting with.
Worth confirming with your own counsel, but the real question is whether a specific contract or regulator requires US residency. HIPAA on its own doesn't.
How the US cluster works
The US cluster is fully isolated, provisioned through a separate plan, and it keeps US users' data in the US. You get a US account with its own API key. Otherwise it's the same thing: same providers, same schema, same context layer. Code written against one cluster works against the other. The only thing that changes is the key.
The setup we recommend
We'd recommend starting EU-only: onboard everyone to the EU cluster and you've got no routing logic, no region tables, and nothing to get wrong on day one.
Add the US later, if you need to. We provision a separate US account with its own API key, and your app chooses which key to use per user based on the region signal you already have. That decision happens once, at onboarding, and from then on that user's data lives in the cluster tied to the key you used. No lookup tables, no per-request routing, no data moving between regions after the fact.
That's the routing. One decision at onboarding, and the user's data lives in that cluster from then on.
Either way, everything else is identical. Our team configures both clusters and walks the routing through with your engineers before anything ships.
What EU processing means under GDPR
For EU users, the data is processed in the EU. No third-country transfer, no standard contractual clauses to negotiate, and a shorter conversation with your DPO. Terra acts as your processor under our DPA, which covers both GDPR and UK GDPR.
Compliance and security, in one place
Because this is the list that ends up pasted into a vendor questionnaire:
- SOC 2 Type II, audited annually.
- HIPAA: we sign a BAA.
- GDPR and UK GDPR: Terra is a processor under our DPA.
- CCPA: service provider.
- Encryption: AES-256 at rest, TLS 1.2 or higher in transit.
- Staff access: MFA and SSO required.
- Monitoring: 24/7, plus independent penetration testing.
Other regions
Today the two standard clusters are EU and US, but they're not the only options. If you have a residency requirement neither covers, specific cluster deployments can be arranged on-demand.
The short version
- Health data lives in Terra's EU cluster by default, for every user, with no configuration.
- HIPAA doesn't require US storage. A contract might. Check yours.
- If it does, we provision an isolated US cluster with its own key. Same providers, same schema, same code.
- Start EU-only. Add the US when you need it. Routing is one line.
- SOC 2 Type II, HIPAA BAA, GDPR and UK GDPR processor, CCPA service provider.
