Data residency is the requirement that data physically remain within a particular country's or state's borders, and the related question of which jurisdictions can legally compel access to it. For a telemedicine product, the data in question is protected health information (PHI), and residency rules determine which cloud regions, storage buckets, and media servers you are allowed to use. It is fundamentally about geography and legal reach, not just about whether the data is encrypted.
The rules come from several sources and do not all point the same way. HIPAA itself does not prohibit storing PHI outside the United States, but customer contracts and hospital procurement terms frequently do require U.S.-only hosting. Several Canadian provinces and many national health systems mandate in-country hosting for health data by law. The EU's GDPR restricts transferring personal data out of the EU/EEA unless specific safeguards are in place. So the same product sold into different markets can face contradictory residency obligations.
The practical implication is architectural, and it is far cheaper to address early than to retrofit. Pin storage to specific regions, route processing through regional paths so that PHI does not transit a forbidden jurisdiction, and pick a real-time media topology (TURN relays and SFUs) placed in the right regions. Crucially, residency applies to your subprocessors too: an AI transcription vendor or analytics provider that quietly processes data in another country can break a commitment you made to a customer. The common pitfall is satisfying residency for your primary database while overlooking a downstream vendor — so maintain a subprocessor list you can actually verify, and confirm where each one runs.
