When Russell Branzell, chief executive officer of CHIME, told an audience at the AHIMA convention that he was "mad as hell," the crowd of hundreds of healthcare information managers roared with laughter and applause.

Branzell is CEO of College of Healthcare Information Management Executives, which represents some 1,400 chief information officers. His fellow panelists – Joseph Fifer, president and CEO of the Healthcare Financial Management Association, and Ann Blouin, executive vice president of customer relations for the Joint Commission – understood where he was coming from.

As Branzell put it, he was not alone in being angry – and worried. Everyone in healthcare is feeling the "tsunami effect," he said.

AHIMA CEO Lynn Thomas Gordon served as moderator for the panel and set up the discussion by asking where the opportunities might be at this time of unprecedented change in healthcare.

"There are so many opportunities," Branzell said.

But, he added, "There are so many things that we need clarity on in our industry. It's very difficult, whether that be interoperability or clear standards."

[See also: CHIME urges changes to meaningful use.]

What concerns him the most, he said, is lack of clarity around patient management.

"I think it's a sad state of affairs when I spend time in hospitals and they can quote to me the number of times they know the patient has been hurt, harmed – or even killed – due to inappropriate patient management."

It is time that the healthcare industry demands a clear standard for a patient identifier, Branzell said, drawing applause from the audience: "I'm mad as hell and I'm not going to take it anymore."

Fifer had similar concerns, viewing them through a finance lens.

"What's going on is this huge risk-shift that's happening, or about to happen, in our industry -- whether it's in the form of payments, or joint deals between payers and providers or acquisitions," he said. "You're seeing a shift of the insurance risk to a number of different folks looking at the whole continuum of care. I'm concerned about the risk shift, frankly, and having the information available to manage in a different way."

Blouin agreed that the shift had been difficult to manage.

"We don't even have the data to be able to even know where we have the problems," she said. "So to start the process, we actually have to go get some middleware, or some other type of technology so we don't have to manually start to collect data on where our high-risk populations are,"

Blouin's biggest concern is that organizations will not have the wherewithal to absorb this much technology and change and do it well.

As Branzell sees it, there's reason for concern.