Is Your Release of Information Process World-Class or Just “Good Enough”?

By Amy Derlink, RHIA, CHA, CHPS, Director of Compliance and Privacy at Verisma 

November 4, 2026 

When a patient, attorney or insurer asks for a copy of a medical record, the stakes are higher than they look. A misdirected page, a missed authorization check, or a late delivery can mean a HIPAA incident, delayed claim, or frustrated patient. In release of information (ROI), “pretty accurate” isn’t a standard anyone should be comfortable with.

So how do you know whether your process is world-class? You measure it. At Verisma, we do that with Six Sigma, and specifically with defects per million opportunities (DPMO).

What is DPMO? 

DPMO is a metric detailing how many errors you would expect if a process were run a million times, and it levels the playing field between simple and complex processes. 

DPMO = (Defects ÷ (Requests × Opportunities per request)) × 1,000,000 

The key idea is the opportunity: any point in a process where an error could occur. A process with more steps has more places to go wrong, and DPMO accounts for that, so you can’t flatter your numbers by simply running a short process.

What is a Sigma level?

Sigma level translates DPMO into an easy-to-read quality scale. Each step up the ladder is dramatically harder than the last: moving from 5 to 6 Sigma cuts defects roughly 70-fold. 

These figures include the standard 1.5 sigma shift used in Six Sigma practice, which accounts for normal process drift over time. 

44 chances to get it wrong 

Every ROI request at Verisma passes through 44 distinct opportunities for error, from request intake and patient identification, authorization validation, record location and retrieval, minimum-necessary review, data integrity, quality check, secure delivery, and documentation. 

That’s 44 places where a human, system or handoff could fail. We don’t hide from that number. We use it as the foundation of how we measure ourselves.

Our number: 1.4086 DPMO 

World-class Six Sigma quality is 3.4 DPMO. Verisma’s DPMO is 1.4086, which puts us beyond the world-class benchmark at roughly 6.2 Sigma. 

To make that tangible: with 44 opportunities per request, 1.4086 DPMO works out to about one defect for every ~710,000 opportunities, or roughly one error in every ~16,900 ROI requests. Even at significant volume, an error is a rare event, not an expected one.

Why this matters to our clients 

• Compliance confidence. In ROI, a defect can be a privacy event. Fewer defects means less risk to your organization and your patients.
• Faster turnaround. Errors create rework, and rework creates delays. A process getting it right the first time moves faster.
• Lower cost of poor quality. Corrections, re-releases, complaints and escalations all cost time and money. Preventing them is cheaper than fixing them.
• Better patient and requester experience. The person waiting on their records doesn’t see our metrics. They see whether their request was right and on time. 

How we get and stay there 

A number like this isn’t an accident, and it isn’t permanent unless we keep earning it. 

1. We count honestly. Our 44 opportunities are defined and held constant. Inflating the opportunity count would make DPMO look better without improving anything, so we don’t change the denominator to flatter the result.
2. We measure continuously. Defects are tracked, categorized and reviewed, not just tallied once a year.
3. We find root causes. When a defect occurs, we ask why until we find the process gap, then fix the process rather than blaming the person.
4. We build quality in. Checks, validations, and standardized work are designed into each step, so quality doesn’t depend on heroics.
5. We keep going. Six Sigma is a discipline, not a trophy. Every defect is a chance to get closer to zero. 

The takeaway 

Whether you’re evaluating an ROI partner or looking at your own operations, ask three questions: 

• Do you know how many opportunities for errors your process has?
• Are you measuring defects against those opportunities?
• How does your DPMO compare to the 3.4 world-class benchmark? 

If the answer to any of those is “we’re not sure,” that’s where improvement starts. 

At Verisma, we know our answer: 44 opportunities. 1.4086 DPMO. World-class and still improving.

See what world-class ROI quality can do for your organization. 

Contact Verisma to learn how our process quality supports your compliance, turnaround, and patient experience goals.