Multi-layer identity in action: a case study

Jem Shaw, 15 September 2025

The following case shows a typical situation where a patient with multiple conditions requires out-of-area care. For the purpose of anonymity, the name and region of the subject have been changed.

Mr Akash Singheera is a 67-year-old man living in the Midlands. He has multiple long-term conditions including type 2 diabetes, chronic kidney disease (CKD stage 3), ischaemic heart disease, and moderate COPD. He takes more than ten medications daily and receives care from several different providers:

• A local community diabetes nurse
• A hospital renal clinic twenty miles away
• A cardiologist at a tertiary centre in another region
• Occasional admissions to different A&E departments when he travels to visit his children.

Akash is widowed and sometimes struggles to keep track of his appointments and medications.

Akash’s care journey

1: Fragmented records at point of emergency care

While visiting his daughter in London, Akash developed breathlessness and presented to a local A&E. The clinicians there had no access to his full medication list or recent test results. Akash could not recall all his medications accurately. As a result, he was prescribed a high-dose diuretic for suspected heart failure exacerbation. He had recently been advised by his renal clinic to avoid this dose due to worsening kidney function, but this information wasn't available. Within days, his kidney function deteriorated significantly, leading to an unplanned hospital admission.

2: Disjointed follow-up

The London hospital discharged Akash back to his GP with a summary letter, but this took two weeks to reach his Midlands GP practice. In the meantime, the renal clinic (who were unaware of the hospital stay) scheduled him for routine follow-up, where staff were surprised to find acute deterioration in blood results. They had no access to the London discharge summary or treatment decisions.

3: Repeat investigations

Akash underwent repeat echocardiograms and blood tests in both the renal and cardiology services. These duplicated tests were stressful for him and costly for the NHS.

4: Poor outcomes

The lack of joined-up information resulted in:

• Avoidable kidney injury from inappropriate medication choice
• Delay in care coordination between renal and cardiology teams
• Duplication of investigations
• Increased anxiety for Akash, who felt “nobody really knew my full story”

5: Analysis

Akash's case highlights the risks of fragmented records across NHS providers. Without a single source of information, clinicians had incomplete information at critical decision-making moments. This led to:

• Clinical harm (worsening kidney disease)
• Service inefficiencies (duplicated tests, unnecessary admissions)
• Reduced patient confidence in the system

For patients like Akash with complex, multi-system needs, fragmented health records directly contribute to poorer outcomes and wasted resource.

6: Possible remedies

A unified patient record across all NHS providers would not only reduce risks and inefficiencies but also restore trust and confidence in care continuity. However, such a solution may be years away, and will require considerable additional investment (at a time when all state expenditure is under pressure). Implementation will involve considerable operational changes, requiring staff training, and leading to an inevitable short term reduction in overall service.

There is another, more practical path, but first let’s consider the benefits that the single patient record would have brought to Akash’s case:

• Given A&E clinicians immediate access to Akash’s medication history and latest renal function results
• Allowed renal and cardiology teams to view discharge notes in real time, avoiding contradictory care plans
• Reduced duplication of tests and improved coordination
• Supported Akash in managing his complex conditions with a clear, consistent plan

Currently, several discrete system across multiple regions and disciplines prevent this outcome. This may be undesirable, but we should remember that these systems evolved to suit the purposes of the services involved. A unified system brings with it the danger of a “one size fits nobody” solution. The alternative is to leave those systems as they are, at least for now, and instead deploy a multi-layer identity system that can be incorporated into the existing structure with little or no modification. Each patient receives an eKeyiD, which can be embedded anywhere in their record, alongside their NHS number or any other identifier. Medications, prosthetics, procedures and any assets, practices, trust or other elements are assigned their own eKeyiDs and nested or related automatically by the CertiQI data vault.

This approach has already proved itself in complex international financial transactions, where global banks, unable to schedule in the cost and upheaval of ISO20022, continue to miss repeatedly adjusted deadlines. Those that have adopted eKeyiD are able to achieve even further improved transparency and efficiency through deploying the simple code over existing SWIFT messaging.

When implemented, the single patient record will greatly alleviate the above problems, but deployment of eKeyiD now can provide a solution almost immediately, fully funded by the savings it achieves. And when the single patient record becomes available, eKeyiD will greatly simplify its use.