What changed in Terra.

Terra accounts

Terra now runs its own sign-in. Create an account with your email and a password of 10 to 128 characters, confirm the address from the link we email you (it works for 24 hours), and finish a short profile with your name and, if you like, pronouns and credentials such as "MD". You can also choose Continue with Google.

• Sessions use short-lived signed tokens (Ed25519) that refresh quietly in the background. Each refresh rotates the token, and reusing an old one ends the session.
• Sign-in sessions, in the account menu under your avatar, lists where you are signed in. End one session, or choose Sign out other sessions.
• Resetting a password signs you out everywhere.
• Your practice has its own sign-in page at app.useterra.si/o/your-practice/login with its name and logo.

Live transcription

Open a visit, go to the Transcript tab, confirm that everyone in the room has agreed to recording, and choose Start live transcription. Words appear while you talk: grey while they are still forming, then final. Each turn carries a speaker label, and you confirm who is the clinician and who is the patient before anything reaches the note.

• Audio streams from your browser to our speech provider. Terra does not store live audio.
• Credits are reserved for the session limit you choose and settled on the actual session time. Unused credits come straight back.
• The microphone next to the Context field and next to each note section lets you dictate into just that part.

Coding suggestions

In Visit workflow → Coding worksheet, choose Suggest codes. Terra reads the saved note and proposes documented diagnoses, each with the exact sentence that supports it and up to three ICD-10-CM codes checked against the release for your date of service. When laterality, acuity or type is missing, the suggestion says so. "Possible" stays possible, and ruled-out findings cannot be added.

Evidence research

Ask a clinical question while you write. Terra plans a few de-identified searches, shows them to you to edit or remove, runs only the ones you keep against PubMed, PubMed Central, DailyMed, openFDA and MedlinePlus, and answers with every statement cited. The answer always lists conflicts and gaps.

Drafting with Gemini or OpenAI

Note drafts, record chat, code suggestions and evidence answers now share one task layer that can run on Google Gemini or OpenAI. Each request uses strict structured output, sends no tools or conversation history, and is quoted before it runs.

Known limits

Code suggestions and evidence answers are advisory: nothing is written to a note, worksheet or library without a separate action from you. Terra does not submit claims.

The new design

Terra has a new look across the whole app: a soft gradient page, one elevated card for the document you are working on, pill-shaped buttons and tabs, and a narrow rail on the left for Visits, Patients, Templates, Library, Insights and Reviews. Light and dark themes follow your system setting, and the toggle in the header overrides it.

Patient tabs

A patient profile now opens on Overview and has tabs for Visits, Documents, Facts, Tasks, History and Settings.

• Overview shows the prepared record brief and what changed since the last signed note.
• Facts holds reviewed allergies, medications and problems, each with its source.
• History is a timeline of visits, signatures, amendments, document reviews, fact changes and tasks.
• Settings is where a clinician who manages the practice assigns a site and restricts access to selected people or care teams.

Visit workflow

The visit editor has a Visit workflow entry for four new tools:

1. Appointment planning: responsible clinician, site, time and duration, with a planning queue in Insights.
2. Documentation readiness: checks the saved note against its template's required sections, open placeholders, current documents and requested reviews before you sign.
3. Patient instructions: written drafts that a clinician approves against the signed note.
4. Export packages: immutable, prepared exports. Downloads are checked against their SHA-256 before the file is saved.

Also new

• Header search across patients, visits and templates (⌘ K).
• A personal Needs attention inbox.
• Usage and plan shows included and purchased credits separately, with any billing holds.

What the pilot included

The first Terra workspace was built for a small group of design partners and ran on synthetic patients only. It covered the core loop of a visit:

• Patients and visits. Create a patient, open a visit, and keep context, transcript and note in one place with version-checked saves, so two tabs never silently overwrite each other.
• Cited drafts. Prepare a draft from the context and transcript. Every section names the sources it used, and a section with no support reads [Not documented] rather than guessing.
• Thirteen built-in templates. SOAP Note, Follow-Up Visit, New Patient, Focused Visit, Telehealth, Chronic Condition, Pain Management Initial and Follow-Up, Imaging Review, Weight Management, Procedure Note, Referral Letter and Patient Instructions. Custom templates can be created, duplicated and edited; built-in ones stay unchanged.
• Writing style. Verbosity (concise, balanced, detailed), paragraphs or bullets, and note language, saved per clinician.
• Signing. A signed note is frozen with a SHA-256 hash. Later changes are dated, attributed amendments, and the original signed text stays readable.
• Recording. Microphone selection, a level meter, pause and resume, and consent before any recording is uploaded.
• Audit history. Practice managers can review recorded actions and export a verified JSON snapshot.

What we learned

Design partners told us three things early: the draft has to know the chart before the visit starts, the transcript has to be visible while the patient is still in the room, and codes are only useful with the sentence that supports them. The releases that followed were built around those three requests.