Healthcare fragmentation—characterized by poor coordination among independently operating organizations—systematically 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.
Mogahed et al. (2026) studied this question.