Our objectives were to compare the proportion of lactating dairy cows diagnosed with health disorders (HD) and herd performance when using a health monitoring program designed to rely primarily but not exclusively on alerts from automated health monitoring (AHM) systems or a health monitoring program based primarily on systematic clinical examinations, milk yield monitoring, and visual observation of cows. In a clinical trial, at ~30 d before expected parturition, nulliparous and parous Holstein cows, stratified by parity and days in gestation, were randomly assigned to the high intensity clinical monitoring (HIC-M; n = 625) or automated monitoring (AUT-M; n = 624) treatment. Cows were fitted with a neck-attached rumination and physical activity monitoring tag and individual daily milk yield data was collected from parlor milk meters. For cows in HIC-M, clinical examination was conducted daily until 10 days in milk (DIM) and then in response to milk yield reduction alerts or visual observation of clinical signs of HD in the course of 21 DIM. For cows in AUT-M, clinical examination until 21 DIM was because of health index (HI) score alerts generated with a combination of rumination time and physical activity and reduced milk yield alerts. Visual observation of clinical signs of HD was used for identifying cows potentially missed by automated alerts. Binomial and quantitative data were analyzed by logistic regression and ANOVA with repeated measures, respectively. The percentage of cows diagnosed with at least one HD during the experimental treatments risk period tended to be greater and the incidence rate ratio of HD diagnosed was greater for the HIC-M than AUT-M treatment. There was no difference between treatments for cows that exited the herd to 60 or 150 DIM, but there tended to be more cows that exited the herd from 61 to 150 DIM for the HIC-M than the AUT-M treatment. There were no differences between treatments for daily or total milk yield to 21 DIM or for weekly mean milk yield and total milk yield to 150 DIM. More cows were inseminated in estrus for first service if in the HIC-M treatment and had no HD diagnosed than if in the HIC-M treatment but with HD diagnosed, or in the AUT-M treatment and had no HD diagnosed. Cows in the AUT-M treatment with HD diagnosed did not differ from other groups. No differences between treatments were observed for pregnancies per AI or pregnancy loss for first service. Despite a reduction in the risk of diagnosis of HD, there was no evidence that a health monitoring program that relied on AHM systems alerts to select cows for clinical examination reduced herd performance when compared with a more intensive program that included systematic clinical examinations of all cows for the first 10 DIM, reduced milk yield alerts, and visual observation. However, to obtain the same herd performance than with the HIC-M treatment, the AUT-M treatment required use of VO. In conclusion, a health monitoring program designed to rely primarily on targeted clinical examination based on alerts from automated health monitoring systems might be a feasible alternative to programs that rely more on clinical examination provided that visual observation is used to identify cows not detected by automated alerts.