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 Norway

 I've always struggled with the navigational concepts, and how they should be used...

There's a lot of probably"useful" concepts in there, but implementing them in a meaningful way seems to be to complex and difficult such that it becomes difficult. I'm not aware of anyone using them in AU.

I get the impression they are clinically relevant concepts, but too difficult to model/outside model, so they've been relegated to the navigational hierarchy. Very similar concepts in the proper hierarchy now...

For example, Arbovirus infection (disorder). This could be a supertype of "Mosquito-borne infectious disease". There's not much difference between these two concepts.
Of course concepts like 'Vibrio species a-m (navigational concept)' are clearly navigational. However, I'm aware of it being used as such.

CSIRO's shrimp browser creates it's own 'navigational type' things, to just group stuff (example) - I think they autogenerate when a concept has too many subtypes.

Our internal tool (Lingo), also uses a few arbitrary "concepts" so that tree view/taxonomy doesn't crash. But these are build into the tool. (0-1, A-E, F-J etc...)

Maybe, they could "be refsets"? But I don't like creating more implementation hurdles.

Use of navigational concepts in value sets seems extremely marginal (and possibly erroneous). I only found 2 value sets in which navigational concepts are used:

• 276886008Peripheral body temperature (navigational concept) used in a Body Temperature value set (among a vast majority of 'observable entity' concepts – possibly an error)

• 395171002 Histology laboratory test (navigational concept) used in a Pathological Assessment value set (among 2 'procedure' concepts – possibly an error)