gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

EBMeDS in Belgium. Discordances between Finnish and Belgian guidelines and consequences related to implementation

Meeting Abstract

  • P. Leysen - Domus Medica, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
  • N. Delvaux - Domus Medica, Antwerp, Belgium; EBMPracticeNet, Leuven, Belgium
  • P. Koeck - Domus Medica, Antwerp, Belgium
  • S. Van de Velde - Domus Medica, Antwerp, Belgium; EBMPracticeNet, Leuven, Belgium
  • J. Michels - Domus Medica, Antwerp, Belgium

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocO09

doi: 10.3205/12gin041, urn:nbn:de:0183-12gin0419

Published: July 10, 2012

© 2012 Leysen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: EBMeDS is a Finnish electronic decision support system that brings evidence based information to the clinician, based on the structured content of the electronic patient record. This system, actually implemented in Belgium, provides tailored reminders, therapeutic suggestions and diagnosis-specific links to guidelines, organized as “scripts”. A critical step is how to deal with discordances between Belgian guidelines for general practice and the Finnish scripts.

Objectives: To compare the EBMeDS-scripts with the locally developped Domus Medica guidelines in order to define the topic coverage and to identify and resolve discordances.

Methods: Early 2011, the 187 publicly available EBMeDS-scripts were assessed by two guideline developers. For each script a local guideline was searched. If a Domus Medica guideline was present, the accordance with the script was assessed. In case of discordance, categorized in minor or major, the evidence that led to the recommendations was studied.

Results: 39 (21%) of the 187 EBMeDS-scripts were covered by a local Domus Medica guideline. Accordance was found in 16 scripts, minor discordance in 18, and major discordance in 5 scripts. Discordances were related with differences in the period of the literature search, as well as disparities in the interpretation of identical references.

Discussion: Local implementation of a well appreciated system as EBMeDS requires a keen strategy that deals with content and context disparities between recommendations from multiple guideline developers.

Implications for guideline developers/users: In spite of strict methodological adherence to EBM principles, guidelines recommendations prove to be sometimes divergent. Protocols in how to deal with these disparities are crucial.