Can't believe nobody has mentioned Indivo yet. http://indivohealth.org/

"Indivo is the original personally controlled health record (PCHR) system. A PCHR enables an individual to own and manage a complete, secure, digital copy of her health and wellness information. Indivo integrates health information across sites of care and over time. Indivo is free and open-source, uses open, unencumbered standards, and is actively deployed in diverse settings, in particular our own Children's Hospital Boston and the Dossia Consortium."

Mod parent up. I also work for a non-evil email marketing company, and the opt-out link DEFINITELY works. You can opt out of commercial email, and not all commercial email is spam.

I can't speak for anyone else, but I stopped running my own mail server when free webmail services got as fast, convenient, and effective at blocking spam. There's no real benefit to running my own server that outweighs the administration effort at this point.