what is the difference between MedicationDispense vs MedicationAdministration fhir? Functionally speaking

I am BA and I'm trying to figure out what is actually retrieved when using one or the other. Devs are all new to this FHIR too.

If you read the descriptions there are subtleties but not clear definitions.

For example, are MedicationDispense medications that my doctor GP prescribed and I bought at the pharmacy? Are MedicationAdministration only those given to me when I am under care at home or hospital? Seems like a thin line.

Solution

MedicationDispense is used to track the supply of a medication (typically a prescribed medication) for patient use. In out-patient settings, it tracks the provision of a supply of medication to a patient or their representative - typically for periods of 30 days or longer. In in-patient settings, it is generally used to track the supply of a medication from the pharmacy to the ward (possibly per day or longer, but sometimes on a per-dose basis). In both cases, it tracks only the supply of the medication, not that it has actually been consumed by the patient. It is not uncommon for a medication to be dispensed but not administered (or not administered as planned).

MedicationAdministration tracks a single consumption of a dose of a medication. A completed MedicationAdministration means the patient is believed to have actually ingested/been injected with/otherwise appropriately therapeutically received the substance. It is typically only used in in-patient settings where a nurse or other practitioner records the occurrence of an injection, an IV adjustment, the witnessing of a patient swallowing an oral medication, etc. However, it can also be created by home health monitoring solutions. E.g. if a patient tracks their medication consumption with a mobile phone app, the app would create a MedicationAdministration instance for each dose of medication the patient (or spouse or other caregiver) records. Aside from that exception, administrations aren't generally tracked for outpatients.

The main differences are:

a MedicationDispense is accompanied by medication instructions indicating the timing and dosage instructions for how the supplied medication should be used. The quantity dispensed is typically sufficient for multiple doses and is NOT necessarily intended to be taken all at once.
a MedicationAdministration is not accompanied by instructions. Instead it simply captures what was administered at a particular point in time, or for IV or other continuous medications, over a specific period of time at a given rate.

The business processes they're associated with are quite different. If you feel the descriptions could be improved to make the differences clearer, feel free to propose language using the 'propose a change' link at the bottom of any page in the FHIR specification.