{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T05:51:05Z","timestamp":1775109065912,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>Healthcare fragmentation\u2014characterized by poor coordination among independently operating organizations\u2014systematically degrades care quality while escalating costs. While healthcare delivery inherently operates as a System of Systems (SoS), existing approaches lack semantic rigor to bridge governance principles with implementable architectures, and digital engineering paradigms remain disconnected from formal representations of regulatory constraints and organizational interdependencies. This paper presents a comprehensive Web Ontology Language (OWL 2 DL)-based ontology integrating structural, behavioral, and regulatory dimensions of healthcare SoS into a unified, computationally tractable framework. Developed following the Methontology engineering methodology and validated using the HermiT reasoner, the ontology formalizes constituent system categories through functional decomposition, establishes an interaction taxonomy distinguishing intra-category coordination from inter-category integration, and introduces the Covenant class as a novel governance mechanism. The covenant embeds legal frameworks (HIPAA, GDPR), interoperability protocols (FHIR, HL7), and technical standards (SNOMED, LOINC, ICD-11, ISO) as first-class ontological entities with explicit relationships to interaction properties. Governance enforcement is operationalized through a layered validation architecture comprising SWRL rules for deductive compliance checking, SHACL shapes for structural constraint validation, and OWL equivalentClass axioms for automated conflict detection. The ontology is further validated through four operational scenarios that demonstrate automated consent validation, standards compliance verification, protocol interoperability checking, and temporal compliance with conflict detection, alongside extended SPARQL queries that reveal constituent system landscapes, standards coverage, interaction networks, and topological properties through node degree calculation, hub identification, and network density analysis. The ontology enables pre-implementation governance assessments, evidence-based policy simulation, digital twin implementations with continuous compliance monitoring, and resilience planning through network analysis, transforming governance from reactive compliance checking to proactive coordination engineering.<\/jats:p>","DOI":"10.3390\/systems14040376","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T16:34:08Z","timestamp":1774974848000},"page":"376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An Ontology-Based Architecture for Interoperable Healthcare Systems-of-Systems: Structure, Interaction Patterns, and Covenant-Based Governance"],"prefix":"10.3390","volume":"14","author":[{"given":"Mohamed","family":"Mogahed","sequence":"first","affiliation":[{"name":"Department of Systems Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mo","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Department of Systems Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1257\/jep.22.4.93","article-title":"Organizational Fragmentation and Care Quality in the U.S. Healthcare System","volume":"22","author":"Cebul","year":"2008","journal-title":"J. Econ. Perspect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3460","DOI":"10.1002\/nop2.1607","article-title":"Fragmented Care and Chronic Illness Patient Outcomes: A Systematic Review","volume":"10","author":"Joo","year":"2023","journal-title":"Nurs. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1377\/hlthaff.2022.01255","article-title":"Integrating the U.S. Public Health and Medical Care Systems to Improve Health Crisis Response","volume":"42","author":"Bourdeaux","year":"2023","journal-title":"Health Aff."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e234355","DOI":"10.1001\/jamahealthforum.2023.4355","article-title":"Health System Change in the Wake of COVID-19","volume":"4","author":"Cutler","year":"2023","journal-title":"JAMA Health Forum"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/sres.2621","article-title":"Complex System Governance: Concept, Utility, and Challenges","volume":"36","author":"Keating","year":"2019","journal-title":"Syst. Res. Behav. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5465","DOI":"10.1109\/JSYST.2021.3106195","article-title":"Design Ontology Supporting Model-Based Systems Engineering Formalisms","volume":"16","author":"Lu","year":"2022","journal-title":"IEEE Syst. J."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Katina, P.F., Keating, C.B., Bobo, J.A., and Toland, T.S. (2019). A Governance Perspective for System-of-Systems. Systems, 7.","DOI":"10.3390\/systems7040054"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Wooley, A., and Womack, L. (2025). Digital Engineering: A Systematic Literature Review of Strategies, Components, and Implementation Challenges. Systems, 13.","DOI":"10.3390\/systems13121046"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hemdan, E.E.-D., and Sayed, A. (2025). Smart and Secure Healthcare with Digital Twins: A Deep Dive into Blockchain, Federated Learning, and Future Innovations. Algorithms, 18.","DOI":"10.3390\/a18070401"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.procs.2021.05.011","article-title":"A Review on Application of Model Based Systems Engineering to Manufacturing and Production Engineering Systems","volume":"185","author":"Akundi","year":"2021","journal-title":"Procedia Comput. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lopez, V., and Akundi, A. (2022, January 25\u201328). A Conceptual Model-Based Systems Engineering (MBSE) Approach to Develop Digital Twins. Proceedings of the 2022 IEEE International Systems Conference (SysCon), Montreal, QC, Canada.","DOI":"10.1109\/SysCon53536.2022.9773869"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Hossain, N.U.I., Lutfi, M., Ahmed, I., Akundi, A., and Cobb, D. (2022). Modeling and Analysis of Unmanned Aerial Vehicle System Leveraging Systems Modeling Language (SysML). Systems, 10.","DOI":"10.3390\/systems10060264"},{"key":"ref_13","first-page":"594","article-title":"Digital Engineering Framework to Develop a Small Space Robotic Arm","volume":"22","author":"Molinar","year":"2025","journal-title":"Aerospace Res. Central"},{"key":"ref_14","unstructured":"U.S. Department of Defense (2026, January 15). Digital Engineering Strategy, Available online: https:\/\/ac.cto.mil\/wp-content\/uploads\/2019\/06\/2018-Digital-Engineering-Strategy_Approved_PrintVersion.pdf."},{"key":"ref_15","unstructured":"International Council on Systems Engineering (INCOSE) (2023). INCOSE Systems Engineering Vision 2035: Executive Summary, INCOSE. Available online: https:\/\/www.incose.org\/docs\/default-source\/se-vision\/incose-se-vision-2035-executive-summary.pdf."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Obrst, L. (2003, January 3\u20138). Ontologies for Semantically Interoperable Systems. Proceedings of the 12th ACM International Conference on Information and Knowledge Management (CIKM \u201903), New Orleans, LA, USA.","DOI":"10.1145\/956931.956932"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.procs.2019.05.079","article-title":"The Ontology of Systems Engineering: Towards a Computational Digital Engineering Semantic Framework","volume":"153","author":"Orellana","year":"2019","journal-title":"Procedia Comput. Sci."},{"key":"ref_18","unstructured":"ISO\/IEC\/IEEE (2023). ISO\/IEC\/IEEE 15288:2023 Systems and Software Engineering\u2014System Life Cycle Processes, International Organization for Standardization. Available online: https:\/\/www.iso.org\/standard\/81702.html."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/sys.21662","article-title":"Driving Digital Engineering Integration and Interoperability through Semantic Integration of Models with Ontologies","volume":"26","author":"Dunbar","year":"2023","journal-title":"Syst. Eng."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1002\/iis2.13210","article-title":"Towards a Systems Engineering Ontology Stack","volume":"34","author":"Gregory","year":"2024","journal-title":"INCOSE Int. Symp."},{"key":"ref_21","first-page":"1727","article-title":"Digital Engineering Strategy to Enable Enterprise Systems Engineering","volume":"30","author":"Noguchi","year":"2020","journal-title":"Syst. Eng."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rhodes, D.H., Ross, A.M., and Nightingale, D.J. (2009, January 23\u201326). Architecting the System of Systems Enterprise: Enabling Constructs and Methods from the Field of Engineering Systems. Proceedings of the 3rd Annual IEEE Systems Conference, Vancouver, BC, Canada.","DOI":"10.1109\/SYSTEMS.2009.4815796"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1504\/IJSSE.2011.040556","article-title":"Systems of Systems Engineering: Prospects and Challenges for the Emerging Field","volume":"2","author":"Keating","year":"2011","journal-title":"Int. J. Syst. Syst. Eng."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1002\/iis2.13218","article-title":"A Rapid Review of How Model-Based Systems Engineering Is Used in Healthcare Systems","volume":"34","author":"Xames","year":"2024","journal-title":"INCOSE Int. Symp."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1017\/pds.2024.160","article-title":"Implementing the model-based systems engineering (MBSE) approach to develop an assessment framework for healthcare facility design","volume":"4","author":"Golgolnia","year":"2024","journal-title":"Proc. Des. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s13753-023-00492-z","article-title":"The Application of Model-Based Systems Engineering to Rural Healthcare System Disaster Planning: A Scoping Review","volume":"14","author":"Berg","year":"2023","journal-title":"Int. J. Disaster Risk Sci."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Madni, A.M., Madni, C.C., and Lucero, S.D. (2019). Leveraging Digital Twin Technology in Model-Based Systems Engineering. Systems, 7.","DOI":"10.3390\/systems7010007"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Vall\u00e9e, A. (2023). Digital Twin for Healthcare Systems. Front. Digit. Health, 5.","DOI":"10.3389\/fdgth.2023.1253050"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"20552076221149651","DOI":"10.1177\/20552076221149651","article-title":"Digital Twin in Healthcare: Recent Updates and Challenges","volume":"9","author":"Sun","year":"2023","journal-title":"Digit. Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100864","DOI":"10.1016\/j.landig.2025.02.004","article-title":"Medical Digital Twins: Enabling Precision Medicine and Medical Artificial Intelligence","volume":"7","author":"Testa","year":"2025","journal-title":"Lancet Digit. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.procir.2021.05.003","article-title":"Integration of Model-Based System Engineering into the Digital Twin Concept","volume":"100","author":"Wang","year":"2021","journal-title":"Procedia CIRP"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1002\/j.2334-5837.2018.00514.x","article-title":"Digital Engineering Models of Complex Systems Using Model-Based Systems Engineering (MBSE) from Enterprise Architecture (EA) to Systems of Systems (SoS) Architectures & Systems Development Life Cycle (SDLC)","volume":"28","author":"Tsui","year":"2018","journal-title":"INCOSE Int. Symp."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.procs.2013.09.276","article-title":"Integration, Verification, Validation, Test, and Evaluation (IVVT&E) Framework for System of Systems (SoS)","volume":"20","author":"Luna","year":"2013","journal-title":"Procedia Comput. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Akundi, A., Ankobiah, W., Mondragon, O., and Luna, S. (2022, January 25\u201328). Perceptions and the Extent of Model-Based Systems Engineering (MBSE) Use\u2014An Industry Survey. Proceedings of the 2022 IEEE International Systems Conference (SysCon 2022), Montreal, QC, Canada.","DOI":"10.1109\/SysCon53536.2022.9773894"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Akundi, A., Euresti, D., Luna, S., Ankobiah, W., Lopes, A., and Edinbarough, I. (2022). State of Industry 5.0\u2014Analysis and Identification of Current Research Trends. Appl. Syst. Innov., 5.","DOI":"10.3390\/asi5010027"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1002\/iis2.13231","article-title":"A New Horizon for Healthcare Delivery: A System of Systems Perspective and Governing Proposition","volume":"34","author":"Mogahed","year":"2024","journal-title":"INCOSE Int. Symp."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Mogahed, M., and Mansouri, M. (2024, January 16\u201319). Navigating the Complexities of Systems of Systems: Analysis, Challenges, and a Novel Proposed Construct. Proceedings of the 2024 IEEE International Symposium on Systems Engineering (ISSE), Perugia, Italy.","DOI":"10.1109\/ISSE63315.2024.10741099"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mogahed, M., and Mansouri, M. (2025). Systems of Systems Governance Frameworks: A Thorough Scoping Review and Synthesis towards Enhancing Healthcare Delivery. IEEE Syst. J.","DOI":"10.1109\/JSYST.2025.3545815"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mogahed, M., and Mansouri, M. (2025, January 26\u201331). Enhancing Healthcare Delivery through Systems of Systems Governance: A Multi-Layered Governance Framework. Proceedings of the 35th Annual INCOSE International Symposium, Ottawa, ON, Canada.","DOI":"10.1002\/iis2.70051"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Mogahed, M., and Mansouri, M. (2025, January 8\u201311). Advancing Sustainable Healthcare Delivery through Systems of Systems Governance and Sustainability Governance Theories. Proceedings of the 2025 20th Annual System of Systems Engineering Conference (SoSE), Tirana, Albania.","DOI":"10.1109\/SoSE66311.2025.11083871"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Mogahed, M., Elahi, A., and Mansouri, M. (2025, January 28\u201330). Operationalizing Healthcare through HHS Mission-Driven Analysis and Functional Categorization for a Governable System of Systems. Proceedings of the 2025 IEEE International Symposium on Systems Engineering (ISSE), Palaiseau, France.","DOI":"10.1109\/ISSE65546.2025.11370072"},{"key":"ref_42","unstructured":"Katina, P. (2026). From Fragmentation to Integration: A Governance-Oriented Architecture Based on Heterogeneous Interactions in Healthcare Systems-of-Systems. From Fragility to Resilience: A Systems Approach to Critical Infrastructure, River Publishers. in press."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Mogahed, M., and Mansouri, M. (2025). Towards Governance of Socio-Technical System of Systems: Leveraging Lessons from Proven Engineering Principles. Systems, 13.","DOI":"10.3390\/systems13121113"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.compind.2019.05.003","article-title":"Ontology-Based Systems Engineering: A State-of-the-Art Review","volume":"111","author":"Yang","year":"2019","journal-title":"Comput. Ind."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s10270-021-00862-5","article-title":"Foundations of Information Technology Based on Bunge\u2019s Systemist Philosophy of Reality","volume":"20","author":"Lukyanenko","year":"2021","journal-title":"Softw. Syst. Model."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"5099","DOI":"10.1080\/00207540412331281999","article-title":"Manufacturing System Engineering Ontology for Semantic Interoperability across Extended Project Teams","volume":"42","author":"Lin","year":"2004","journal-title":"Int. J. Prod. Res."},{"key":"ref_47","unstructured":"Huang, Y., Douib, S., Medinacelli, L.P., and Malenfant, J. (2022, January 28). Enabling Semantic Interoperability of Asset Administration Shells through an Ontology-Based Modeling Method. Proceedings of the ACM\/IEEE 25th International Conference on Model Driven Engineering Languages and Systems (MODELS 2022), Montr\u00e9al, QC, Canada."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.future.2013.08.003","article-title":"Creating a Semantically-Enhanced Cloud Services Environment through Ontology Evolution","volume":"32","year":"2014","journal-title":"Future Gener. Comput. Syst."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Barangi, H., Rahimi, S.K., Zamani, B., and Moradi, H. (2023, January 25\u201326). An Ontology-Based Approach to Facilitate Semantic Interoperability of Context-Aware Systems. Proceedings of the 2023 28th International Computer Conference, Computer Society of Iran (CSICC), Tehran, Iran.","DOI":"10.1109\/CSICC58665.2023.10105364"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Arp, R., Smith, B., and Spear, A.D. (2015). Building Ontologies with Basic Formal Ontology, MIT Press.","DOI":"10.7551\/mitpress\/9780262527811.001.0001"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Kn\u00f6\u00f6s Franz\u00e9n, L., Staack, I., Jouannet, C., and Krus, P. (2019, January 8\u20139). An Ontological Approach to System of Systems Engineering in Product Development. Proceedings of the 10th Aerospace Technology Congress, Stockholm, Sweden.","DOI":"10.3384\/ecp19162004"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Feng, Y., Zou, Q., Zhou, C., Liu, Y., and Peng, Q. (2023). Ontology-Based Architecture Process of System-of-Systems: From Capability Development to Operational Modeling. Appl. Sci., 13.","DOI":"10.3390\/app13095419"},{"key":"ref_53","unstructured":"Qaddoumi, E., Odeh, M., Khan, Z., Kossmann, M., Traish, I., and Tbakhi, A. (2017, January 12\u201313). OntoSoS.QM.Gov: A Quality Governance Framework for Systems of Systems. Proceedings of the Complex Systems Design and Management Conference, Paris, France."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ghosh Mitra, S., Chandra, A., and Ramaprasad, A. (2024). The Ontology of Urban Governance: A Framework for Pathways to Sustainable Urban Transition. Urban Sci., 8.","DOI":"10.3390\/urbansci8020038"},{"key":"ref_55","unstructured":"Fern\u00e1ndez-L\u00f3pez, M., G\u00f3mez-P\u00e9rez, A., and Juristo, N. (1997). METHONTOLOGY: From ontological art towards ontological engineering. Proceedings of the AAAI97 Spring Symposium Series on Ontological Engineering, AAAI Press."},{"key":"ref_56","unstructured":"(2026, January 15). Prot\u00e9g\u00e9 5.6.7, Developed by the Stanford Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA, USA. Available online: https:\/\/protege.stanford.edu."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s10278-018-0069-8","article-title":"Standard Lexicons, Coding Systems and Ontologies for Interoperability and Semantic Computation in Imaging","volume":"31","author":"Wang","year":"2018","journal-title":"J. Digit. Imaging"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Chatterjee, A., Pahari, N., and Prinz, A. (2022). HL7 FHIR with SNOMED-CT to Achieve Semantic and Structural Interoperability in Personal Health Data: A Proof-of-Concept Study. Sensors, 22.","DOI":"10.3390\/s22103756"},{"key":"ref_59","unstructured":"CVS Health (2025, January 18). MinuteClinic. Available online: https:\/\/www.cvshealth.com\/services\/health-care-and-wellness\/health-services\/minuteclinic.html."},{"key":"ref_60","unstructured":"U.S. Department of Health and Human Services (2025, January 26). About HHS, Available online: https:\/\/www.hhs.gov\/about\/index.html."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Mogahed, M., Elahi, A., and Mansouri, M. (2025, January 28\u201330). Optimizing Healthcare Clinical Decision Support Systems: A Systems Thinking and Process Modeling Approach. Proceedings of the 2025 IEEE International Symposium on Systems Engineering (ISSE), Palaiseau, France.","DOI":"10.1109\/ISSE65546.2025.11370065"}],"container-title":["Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-8954\/14\/4\/376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T04:28:50Z","timestamp":1775104130000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-8954\/14\/4\/376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":61,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["systems14040376"],"URL":"https:\/\/doi.org\/10.3390\/systems14040376","relation":{},"ISSN":["2079-8954"],"issn-type":[{"value":"2079-8954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}