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Concepts that cannot be fully defined using the current concept model are called primitive concepts. Primitive concepts cannot be fully acted upon by the classifier; consequently subtype concepts are not assigned via the classification process. Instead, to create subtypes, each relevant concept must be identified and the IS_A relationship stated manually. 

When a primitive concept sits as a child of one or more concepts and as a parent of one or more concepts, it is known as an intermediate primitive.


116223007 | Complication (disorder) |

All children of this concept have an IS_A relationship manually authored. As a result, determining all the related children is difficult hence all relevant subtypes may not be present.




Identifying all members during development of a subset or all relevant content for data retrieval is thereby less than optimal. Consideration also needs to be given to the addition of new concepts as any potential primitive parents need to be identified and the IS_A relationship manually stated. This places the burden on the author to locate all relevant supertype primitive concepts in the current content and create the relationship.   



Given the potential implications of this manual process, the addition of an intermediate primitive concept is prohibited unless:

  • There is no other option and the concept is clinically necessary.
  • The impact of adding the concept in question has been fully explored and understood.
  • The impact is deemed manageable and a plan for management has been determined. This should include an extensional definition for the direct sub concepts.

For the international release, such requests will be assessed on a case-by-case basis using the content development process for content issues.