What are clinical guidelines and where did the term come from?

25.10.2023

Clinical guideline practices (CGPs), also known as Evidence-Based Medicine (EBM), are a systematic and methodical approach to medical practice. They are procedures describing the steps of the diagnostic and therapeutic process based on the best possible evidence and experience - hence the name Evidence-Based Medicine.

The main goal of the KDP is to ensure the best possible medical care in diagnosis, treatment and other care provided to patients. They are primarily developed by professional societies, independent organisations or expert groups and provide specific recommendations for the diagnosis and treatment of various medical conditions. They also serve to guide physicians and health professionals in the delivery of health care and to standardise these practices. The establishment and adherence to the KDPs can also be seen as a guarantee of a uniform level and quality of healthcare services. Important sources of KDPs include the World Health Organisation, various medical associations and societies and, last but not least, academic institutions.

A doctor must always act in accordance with 'lege artis', i.e. in accordance with the appropriate professional standard, or in accordance with the professionally correct procedure. In order for the criterion of lege artis to be fulfilled, it is therefore necessary that the doctor also act in accordance with the KDP. If any intervention is carried out non lege artis, and therefore contrary to professionally correct practice, one of the prerequisites for the liability of a health care provider for causing personal injury will be fulfilled. However, it is not always possible in practice to follow strictly the established recommended procedures for a particular patient. Therefore, the responsibility for the chosen procedure for a particular patient always lies with the doctor, which entails the obligation to properly justify the procedure in the medical records, especially if the doctor deviates from generally accepted procedures for a particular patient.

Given the speed of development and change in healthcare, CPD is also a very dynamic field and it is essential that doctors and healthcare professionals constantly update their practices and, above all, their knowledge. However, at present, KDPs are not regulated in legislation.

The pending amendment to Act No 372/2011 Coll., on Health Services and Conditions of their Provision (Health Services Act), as amended, may contribute significantly to this. This amendment deals not only with telemedicine, which you can already find elaborated in previous articles, but also with the concept of KDP, in the context of the National Health Information System (hereinafter referred to as "NHIS").

The amendment under discussion thus introduces the concept of KDP into the text of the Act, specifically into the provisions of Section 70 of the Health Services Act. As they have not been centrally assessed or registered so far, the explanatory memorandum states the necessity of capturing KDPs with a link to the central data sources of the NHSIS to ensure full accessibility for health service providers. The amendment is further intended to enable the assessment of compliance with KDPs based on central eHealth data across the health system without administrative burden for health professionals.

This has led to the creation of a national KDP portal (available online here: https://kdp.uzis.cz/), where KDPs are progressively uploaded, which may represent one of the tools to help eliminate cases of non lege artis practices, and a positive contribution to patient care in general. As already outlined above, following an erroneous procedure, the liability of the healthcare provider for the harm caused to the patient's health may be inferred.

The amendment thus takes on added significance in the context of the aforementioned elimination of non lege artis practices and the widening of the availability of KDP for health service providers who may be directly involved.