Ontology-Aware Design Patterns for Clinical AI Systems: Translating Reification Theory into Software Architecture

Clinical AI systems routinely train on health data structurally distorted by documentation workflows, billing incentives, and terminology fragmentation. Prior work has characterised the mechanisms of this distortion: the three-forces model of documentary enactment, the reification feedback loop through which AI may amplify coding artefacts, and terminology governance failures that allow semantic drift to accumulate. Yet translating these insights into implementable software architecture remains an open problem. This paper proposes seven ontology-aware design patterns in Gang-of-Four pattern language for building clinical AI pipelines resilient to ontological distortion. The patterns addre...

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