Table 1. The effect of CDSS on ADEs .

References	CDSS focus ( study objective)	Effect measures	Main findings
(24)	The relationship between CPOE with CDS and the occurrence of an adverse drug event (ADE)	Decreased ADEs	80% decrease in ADEs by using CPOE with CDS
(69)	Identification of automated/non-automated systems that can eliminate/reduce prescriptions that may cause ADEs at the patient level and their effectiveness	Eliminate/reduce prescriptions	Various systems, including CPOE with DSS can reduce/eliminate prescription of medications that cause ADEs. However, little evidence exists for supporting that. To show the benefits of such systems in medical care, further studies are required.
(70)	Assessing the effect of computerized laboratory alerts on lowering ADEs rate and process outcomes	Promotion of choosing clinical outcomes and process outcomes	No evidence exists about the usefulness and benefits of computerized clinical alerts. However, there was some improvement in process outcomes, including changes in laboratory behaviors and prescribing behavior. Therefore, more evidence is needed to prove the usefulness of such systems in electronic medical records.
(71)	Assessing the effect of CPOE on elimination/decrease in medicine errors and ADE	Elimination/decrease in medicine errors and ADE	Findings showed that automated prescription and decision support system could be useful in the elimination/decrease in medicine errors and ADE in clinical settings such as hospitals.
(72)	Assessing various clinical alerts such as pharmacy and laboratory signals currently used to measure ADEs in hospital	Promoting ADEs’ detection	The results showed that clinical alerts such as pharmacy and laboratory signals had been improved to identify ADEs. However, more research on this subject is needed to assess the use of such signals and CDS systems in different settings and analyze the system economically.
(73)	Detecting factors that are most effective in the elimination/reduction of medication error and evaluating the effect of CPOE in the elimination/reduction of preventable ADEs.	Substantial decrease in medication errors and preventable ADEs	More than 50% use of CPOE to decrease preventable ADEs and medication errors
(74)	Measuring the cost-effectiveness of CPOE and its capability to eliminate/reduce preventable ADEs and medication errors	Elimination/reduction of preventable ADEs and medication errors	The combination of CPOE and decision support systems can eliminate/reduce SDEs and medication errors
(75)	Measuring the capability and economic usefulness of drug interaction detection software (DIS) in elimination/reduction of ADEs	ADEs’ rate did not change	The outcomes of DIS (benefits, consequences, and economic usefulness) and its effect on drug safety were not detected.