HealthyEmail - Zixcorp links - One company or two?

In response to this post in my weblog on 2/28 .. I received the following e-mail:

Dr. Reider - I'm passing on the following from Stacy Smith, Executive
Coordinator of HealthyEmail, regarding your 2/28 posting on www.docnotes.com.  Please
feel free to use the following in it's entirety there, and to contact us if you
have any questions concerning the HealthyEmail initiative.  Thanks.

March 7, 2003

Dear Dr. Reider,

I was recently apprised of a posting on your website, Family Medicine Notes,
dated Friday, February 28, 2003 and felt compelled to contact you to clarify
several misconceptions about HealthyEmail. HealthyEmail is a nonprofit
organization, recently created to maximize the potential of email use in the healthcare
industry. The organization is addressing the increasing problems involving
physicians' email communication with patients, hospitals, insurers and other doctors,
particularly where sensitive patient information is involved. 

HealthyEmail is not one in the same with Zix Corporation. To be sure, ZixCorp
has been integral to the formation of our initiative, providing us with seed
funding, facilities and some manpower to jump start HealthyEmail operations, as
well as a grant of two million licenses of ZixMailTM. These resources came at a
very critical time for our organization as we had a short amount of time to
accomplish a great deal.  However, despite ZixCorp's initial support, their
"control" over HealthyEmail is limited to one vote on our nine-person Advisory Board. 
As the Healthy Email operations move into higher gear, I anticipate that one or
more of the companies represented by advisory board members will also make
financial contributions.  We're also hoping that other companies in the industry
will step forward to support this initiative as it becomes better known. I also
want to note that the initial HealthyEmail tool set includes more than just the
ZixMail application. It includes educational materials, policies and patient
pamphlets.

The HealthyEmail program came about out of interest from the industry to
address the problems around adoption of secure email by physicians and their staffs.
After discussions with various industry organizations, it became apparent that
adoption of secure email by physicians was a concern and of interest to a
significant number of industry organizations, and that the answer was a combination
of education, process and technology, which was greater than anyone healthcare
organization. 

As for the matter of the licenses of ZixMail being free for two years, they are
exactly that.  That verbiage that was discovered in the licenses, regarding the
30-day trial period, was inadvertently carried over from standard ZixMail
licenses. This oversight is being corrected as I type. Finally, regarding the
concern you raised about luring physicians in with a free offer and then charging
them a premium after the free period has expired: The intention was to provide the
tool for a reasonable amount of time for organizations to understand the
benefits of secure email. As this has been a frequent question, discussions have been
taking place to provide the licenses at a very reasonable price after the two
years has expired. I hope to have this issue resolved in the next few weeks.

Any organization that would like to learn more, or who would like to
participate in the HealthyEmail initiative, should not hesitate to contact me at
866-251-4949.

Very truly yours,

Stacy S. Smith
Executive Coordinator

--

And I responded ... My response ( along with his replies in caps) follows:

Dr. Reider,

For clarity, I'll insert my answers to your question, below, in CAPS.  Tx.

-----Original Message-----
From: Jacob Reider 
Sent: Sat 3/8/2003 11:00 AM
To: Breslin, Mike
Cc:
Subject: Re: HealthyEmail



Mike:

a) I will post the letter

b) She makes no mention of patient fees.  As I understand this - the
physicians get something for free (for 2 years) and the patients get nothing.  Patients
would have to purchase zixmail licenses .. am I incorrect?  This still seems
like a promotion of Zix services.

NO, PATIENTS DO NOT HAVE TO PAY FOR ZIX LICENSES.  ONCE A DOCTOR SIGNS UP WITH
HEALTHYEMAIL, HIS OR HER PATIENTS CAN COMMUNICATE WITH THEIR DOCTOR FREE OF
CHARGE VIA THE HEALTHYEMAIL MESSAGING PORTAL.

c) Many of the educational materials are available in other places (such as
Danny Sands' own website!) ...

WITH REGARD TO THE EDUCATIONAL MATERIALS, OUR INTENTION IS TO DISSEMINATE THEM
AS WIDELY AS POSSIBLE.  SO, THE FACT THAT DR. SANDS (A MEMBER OF OUR ADVISORY
COUNCIL) HAS THEM ON HIS SITE IS NOT SURPRISING.

d) I'm sorry if I don't 'get it' ... while I agree that this is an important
topic, and you have certainly pulled together some of the 'best and brightest'
from healthcare informatics, the association with Zixcorp seems awfully strong. 
The educational materials are fine, but clearly available elsewhere ... and the
only significant 'product' of HealthyEmail is the Zix product. 

WHILE SOME OF THE MATERIALS AND MAY BE AVAILABLE ELSEWHERE, I'M NOT AWARE OF
ANY OTHER INITIATIVE THAT IS PROVIDING AS BROAD AN ARRAY OF TOOLS, SOFTWARE,
EDUCATIONAL MATERIAL AND TECH SUPPORT IN A SINGLE PLACE AS IS THE HEALTHYEMAIL
WEBSITE.  XIZCORP IS A STRONG SUPPORTER OF THIS EFFORT, TO BE SURE; BUT THEIR
SUPPORT SHOULD NOT BE CONFUSED WITH CONTROL.

e) One vote of nine on an advisory board is one thing .. but an advisory board
does not govern the company, as I am sure you would acknowledge.  Who is on the
board of directors of HealthyEmail?  That's the more interesting question.

THE IS NOT A BOARD OF DIRECTORS.  THE ADVISORY COUNCIL IS THE SENIOR MOST
AUTHORITY WITH THE HEALTHYEMAIL PROGRAM, AND THE PROGRAM'S EXECUTIVE COORDINATOR
(STACY SMITH) ANSWERS TO THEM.

Thanks.

I'll call next week.  I don't mean to be adversarial .. but I think that it's
important that things be clear .. and so far .. HealthyEmail .. and the
motivation for the promotion of HealthyEmail remains unclear to me.  If the goals are
truly altruistic - as is implied but the nonprofit status - then clarity should
emerge as our conversation proceeds.

I AGREE THAT CLARITY IS IMPORTANT, AND APPRECIATE YOUR CANDOR.  DON'T HESITATE
TO CALL OR EMAIL ME WITH ADDITIONAL QUESTIONS.

- JMR
---------

So it's clear now that I was incorrect about patients paying (they don't) but physicians will pay after the two years.  They'll fix the license to that it says 2 years instead of 30 days as it did when I downloaded it.

But his response about the governance of the "program" remains vague.  He says that Ms. Smith answers only to the advisory board.  This doesn't make much sense to me, as an advisory board usually functions in a role that would help the leadership of a company to make strategic decisions.  If this is a corporation, there would have to be documents that would say who the directors of the company are .. who owns the company, etc ...

So I do a little research.

It's a Texas not-for-profit corporation (and a Delaware not-for-profit corporation)

The interesting part is that the CEO of Zixcorp is listed as the Director of HealthyEmail.
And the applicant for the corporate entity in Texas was named as "Zixcorp."

So while I suppose they are being technically accurate that Zixcorp and HealthyEmail are not one and the same ... it is rather clear that Zixcorp caused HealthyEmail to exist.

This isn't bad.  Indeed, it's a good idea for a company that develops software for physicians communicate securely with their patients to create a good marketing tool.

Yet it doesn't seem right that they are pretending the HealthyEmail product wasn't created to promote the use of Zixmail.  So I send another e-mail:

Mike ..

a) OK .. so I found the not-for-profit application from the Texas Secretary of State:

a) John Ryan is listed as Director of the company
b) A board of advisers has no authority in a not-for-profit corporation. 
c) see attached.  Zixcorp applied for the entity.

I see no evidence of an autonomous not-for-profit with a primary goal of enhancing the security of physician-patient communication.  I see ample evidence of a "shell" company that was set up to build long-term demand for a commercial product.

- JMR

He hasn't responded.

As I mention in the initial letter -- I have no axe to grind here.  Zixcorp makes good software and they certainly have every right to promote the use of that software, especially with the HIPAA privacy compliance date ~ 1 month away ...  but it does irk me that they're playing this not-for-profit game.  If HealthyEmail was truly autonomous .. they could decide to implement one of the (many) other web-based physician-patient collaboration systems out there such as aboutmyhealth.com, or RelayHealth or mdhub or medfusion.