Monitoring for adverse drug events of high-risk medications with a computerized clinical decision support system: a prospective cohort study.

This article focuses on the development and evaluation of a clinical decision support system (CDSS) designed to improve monitoring for high-risk medications in an outpatient setting at a tertiary care teaching hospital in Japan. The CDSS automatically alerts physicians and facilitates ordering recommended tests—such as liver function tests for vildagliptin, thyroid function tests for immune checkpoint inhibitors (ICIs) and multikinase inhibitors (MKIs), and slit-lamp eye examinations for oral amiodarone—when such monitoring has not been performed within specified timeframes. A prospective cohort study comparing one year before and after CDSS activation showed a significant decrease in alerts and an increase in monitoring for vildagliptin, while increases for ICIs/MKIs and amiodarone were not statistically significant. Despite these improvements, the overall acceptance rates of CDSS alerts by physicians were limited, highlighting challenges in alert fatigue and clinical relevance. The study suggests that while CDSS can enhance adherence to monitoring recommendations for certain medications, further research is needed to optimize alert systems and assess their impact on clinical outcomes.