Introduction
Once you recognize the importance of architecture reviews in connected device development, the next question is how to actually run one—especially when the stakes include regulatory approval, data security, and clinical reliability. In regulated environments, good architecture is more than clean design, it’s a critical foundation for product viability.
But architecture reviews don’t just happen. They need structure, timing, and buy-in across teams. And for connected medical ecosystems, they need to address the nuances of interoperability, traceability, and evolving requirements without slowing you down.
What You’ll Get
This article breaks down the cloud architecture review process into practical, repeatable steps, whether you’re working in a traditional waterfall model or adapting to Agile. You’ll learn:
- How to identify decisions worth reviewing
- What goes into an effective architecture proposal
- How to validate decisions in high-stakes, evolving systems
- How to integrate reviews into Agile workflows using ADRs
- When to seek outside input to avoid hidden risk
Whether you’re facilitating a formal review or trying to build a more resilient decision-making culture within your team, this guide will help you structure a process that fits your system and your stage.
If you’re still deciding whether an architecture review is worth it, this article outlines why they’re critical for connected medical systems.
What Does the Cloud Architecture Review Process Look Like?
There’s no one-size-fits-all approach to architecture reviews. Some organizations lean toward upfront design, reviewing architectural decisions early in the project before implementation begins. Others take a more iterative, Agile approach—evaluating architectural components as they emerge throughout development.
Regardless of development methodology, there are common elements that make architecture reviews more effective. The steps below illustrate a typical structure, but the depth and format may vary depending on your system’s complexity, development phase, and internal experience.
Step 1: Identify Architecturally Relevant Decisions
The first step is surfacing the decisions that warrant deeper scrutiny. A helpful rule of thumb: if a design choice affects more than one team, or involves a third-party dependency, it’s likely architecturally relevant.
In early stages, this often includes broader system considerations like supported programming languages, naming conventions, cloud providers, or external services. For example, when evaluating third-party tools or services, the goal isn’t always to decide immediately whether to use them—it’s to understand under what circumstances they’re a good fit, and when they might introduce risk.
The earlier these questions are raised, the easier it is to make informed decisions before dependencies become entrenched in the system and before downstream changes become costly or disruptive.
Decisions around tools, services, or integrations often emerge early, sometimes before teams realize how much they’ll shape the project’s scope. These five scope-related considerations can help teams frame those early discussions more clearly.
Step 2: Look for Existing Patterns or Solutions
Before designing something new, teams should ask: has a similar decision already been made elsewhere in the organization? If a proven solution or design pattern exists, reusing it can speed up development and reduce risk.
However, reuse isn’t always one-to-one. Teams should assess whether the existing approach is flexible enough to apply to the current situation, or if only parts of it are worth adopting. In some cases, this may lead to new decisions around generalizing shared functionality into libraries or services to make future reuse easier.
Even if the full solution doesn’t apply, it might reveal patterns or components that can be adapted, highlighting opportunities to reduce duplication and increase consistency across the system.
Step 3: Propose a Solution
Once a relevant decision is identified, the next step is to develop and document a proposed solution. This should include:
- Benefits and tradeoffs
- Cost and licensing implications
- Potential for reuse or long-term support
- Any alternatives considered, and why they were rejected
For connected health systems, proposals should also account for compliance impact and interoperability, especially when patient data or regulated endpoints are involved.
Depending on the complexity, this step may also involve building a lightweight prototype to validate that the solution will work with the existing architecture. This could be as simple as testing basic compatibility in your environment, or as involved as integrating a new architecture into a subset of the system to ensure multiple components can work together.
At this stage, the goal is not to fully implement the solution but to gather enough information to make a well-informed architectural decision.
Step 4: Collect Feedback
Once a proposal is documented, it should be shared for review. The review process doesn’t need to be formal, but it should include the right voices, especially stakeholders who will be impacted by the decision, or who own intersecting areas of the system.
Feedback can be collected in various ways, such as asynchronous channels like Slack, live discussions, or more structured review meetings. What matters most is giving people a chance to weigh in, identify edge cases, and surface potential conflicts.
Feedback might lead to minor revisions or, in some cases, a shift in direction. For example, a proposed cloud resource might introduce new compliance requirements, or a hardware integration might expose a previously overlooked security concern. The team proposing the solution should work with others to adjust the recommendation accordingly, ensuring concerns are resolved and well-documented.
Step 5: Make a Decision
Once feedback has been incorporated, a final decision can be made. Some organizations have formal Architecture Review Boards (ARBs) that own this step, while others rely on collaboration between the proposing team and a technical lead or architect.
The decision should be recorded in the system’s architectural documentation and include:
- The problem the decision was intended to solve
- The options considered and their respective pros and cons
- The final solution and when to apply it
- Guidelines for validating that the implementation aligns with the design
If no single solution addresses all use cases, the documentation should reflect when and where each option applies.
For architectural decisions around medical APIs or cloud-connected apps, this article offers deeper guidance on building reliable, compliant interfaces.
Step 6: Implement and Validate
With the decision made, teams move into implementation, but that doesn’t mean the review process is over. It’s critical to ensure the final implementation reflects the intended architecture. This can happen through code reviews, QA testing, or as part of release readiness checks.
As systems evolve, so do requirements and technologies. In regulated environments like connected medical systems, this makes validation even more important—not just for performance and functionality but also to ensure the implementation continues to meet safety, privacy, and compliance expectations over time. A solution that made sense six months ago might no longer be the best fit.
Having a clear record of the decision—what was considered, what was rejected, and why—gives teams a strong foundation to revisit architectural choices as needed without starting from scratch. It’s not just about enforcing conformance, it’s about enabling agility through documentation and context.
Agile Architecture Review
Organizations transitioning to Agile development practices often struggle to reconcile traditional architecture processes with the iterative nature of Agile. This is especially true for teams accustomed to designing the entire architecture upfront, before implementation begins. In contrast, Agile expects architecture to evolve alongside the product, adapting to changes in requirements over time.
This challenge is especially pronounced in connected medical device development, where Agile needs to align with documentation, traceability, and safety requirements. As teams build and iterate, they encounter a steady stream of Architecturally Relevant Decisions. Rather than trying to predict all of them in advance (or scrambling to document them retroactively) Agile teams review and capture these decisions as they arise.
Using ADRs to Support Agile Architecture
A common and effective approach is to use Architecture Decision Records (ADRs). These are lightweight documents that capture a specific problem, the proposed solution, and any alternatives considered. When stored in the code repository alongside the relevant component, ADRs are easy for developers to maintain during implementation. They also allow architects to use existing tooling (e.g., peer reviews, pull requests) to participate in architecture reviews without creating a separate process.
ADRs serve a dual purpose: they preserve the rationale behind key decisions and provide valuable onboarding context for new developers. Because they live with the code, they’re more likely to stay up to date, and they encourage the same iterative, flexible approach to architecture as Agile promotes for development.
Maintaining Alignment as Systems Evolve
When architectural decisions span multiple components or teams or involve broader changes, developers can collaborate with architects to coordinate and document the impacts. These broader decisions should be stored in a shared location and reviewed by all affected teams to ensure alignment across the system.
As requirements shift or new technologies emerge, having a record of past decisions—including the reasoning behind them—makes it easier to revisit old choices with clarity. Even if the team decides to stick with an existing solution due to cost or effort, simply acknowledging the tradeoffs helps future teams understand what’s possible and why certain paths were (or weren’t) taken.
That said, not every architecture decision needs to be made in isolation, especially when the stakes are high or the unknowns are deep.
When to Seek External Support
Not every team has the internal bandwidth or perspective to manage all reviews solo, especially when the risks are system-wide. While many architectural decisions can be handled internally, there are moments when an outside perspective becomes critical.
If you’re operating in a regulated environment, dealing with system-wide complexity, or scaling a connected product into production, a focused architecture review can uncover risks before they impact product viability or patient safety. In these moments, a well-timed external review can bring clarity, challenge assumptions, and uncover architectural blind spots that internal teams may overlook.
Working with the right partner early on can turn architecture from a potential liability into a lasting competitive advantage. If you’re navigating one of these inflection points, contact us to explore whether a structured review could help your team avoid costly missteps.
Conclusion
Cloud architecture reviews aren’t just a best practice—they’re a strategic safeguard for connected medical systems. In fast-moving, regulated development cycles, they create space for thoughtful decisions, reduce the risk of rework, and help teams align around what matters most.
By embedding a structured review process into your workflow, especially through tools like ADRs, you give your teams the ability to adapt confidently, maintain traceability, and build with purpose. It’s not about slowing things down—it’s about building systems that are scalable, secure, and resilient enough to support real-world use.
Architecture isn’t just a technical concern. It’s a strategic asset that ensures your platform can scale, comply, and align across teams.
