Maastro Clinic is the largest radiotherapy clinic in south-east of the Netherlands. At the heart of its IT landscape is the crown jewel: a unique piece of custom software around which a treatment platform has been created. Nothing happens here without IT. Although the IT component is playing an increasingly important role in Maastro Clinic's primary process, the healthcare provider wished to do the minimum amount of programming itself. Instead, the organisation is actually building ecosystems with partners. That offered Open Line the opportunity to move up the value chain.
Maastro wishes to administer radiotherapy treatment as accurately as possible. The tumour then receives the required dose, but the surrounding tissue receives as little radiation as possible. This minimises any negative side effects of radiotherapy. To achieve this, Maastro is committed to new treatment methods such as proton therapy. But Maastro also pursues this objective in photon treatment. They do this by optimising the effectiveness of each treatment session based on complex image and data analysis. In this process, software repeatedly calculates the best dose distribution of photons based on a variety of dynamic patient data, scans, treatment data and influence factors.
Moving up the value chain
Open Line and Maastro Clinic have been working together for some time. Ten years ago, Open Line probably could not have imagined that the collaboration with Maastro Clinic would expand to IT support in areas of specialised medical expertise.
The collaboration started with providing technical management of the IT hardware and co-creating the workplace. But office automation is fundamentally different from automation of medical information systems. Among the medical experts at Maastro Clinic, ideas on the application of medical data extended far beyond the IT knowledge available. For Open Line, the range of tasks expanded significantly when Maastro Clinic conceived the idea of replacing the existing PACS (Picture Archiving and Communication System) because the current solution had already been end-of-support for two years. “When Open Line got wind of this, they made a move: we can also help you in the field of patient portals and medical data storage”, says Enno Soeren, operations manager.
Maastro Clinic develops research software in-house
This software and the associated software updates must be thoroughly tested before they can be implemented. Maastro Clinic was looking for a way to qualitatively improve this process, including by improving the measurement of updates, results and quality across the environment.
Open Line has provided an OTA environment that replicates in detail the production environment and in which new versions of the software developed by Maastro Clinic can be thoroughly tested, technically and functionally, before being installed in the production environment. The OTA environment and the production environment are each located in a separate ‘cloud’. An innovative device allows switching between the test and production environments, so the production environment never has to be shut down to test new software in real life. This approach ensures that new software can be rolled out more quickly and reliably.
Open Line helps build chain-based platform
The treatment method at Maastro Clinic involves optimising a new radiotherapy session within a treatment programme based on the results of a previous radiotherapy session. This means that large amounts of data – primarily medical images – have to be stored and analysed in real time using software. The analysis results are input for the adjustment of the radiotherapy programme, which is then communicated to the radiotherapy equipment. These patient data, scans and treatment data must be analysed in near real-time in order to make same-day treatment decisions. This places special demands on the storage and availability of data and software.
This data-intensive treatment method of Maastro does not stand alone, but is part of the care chain in which – in addition to patients – health insurers and other treatment centres also play a role. Data and information must be able to be exchanged with different systems in a - needless to say - secure and reliable manner. Treatment results are also stored in aggregated form in the EPR, which also contains other medical information, as well as planning and financial software for billing to insurers and planning and referral systems.
Open Line has made a serious contribution to the creation of an integrated and scalable treatment platform centred on Maastro Clinic’s primary process, which also accommodates data from different hospitals in the Netherlands. “It is an ecosystem with solutions from various providers working together”, according to Soeren. Open Line is continuing to play an important role in expanding that platform. This includes items such as regional data exchange or the further development of a personal Maastro environment. For this purpose, Maastro Clinic uses Open Line's Smart Cloud Storage and Smart Cloud Backup services, which are integrated into the infrastructure.
Open Line has moved up the medical value chain significantly in recent years. “Compared with ten years ago, the character of our IT partner has changed considerably”, says Maria Jacobs, CEO of Maastro Clinic. “Open Line has noticeably specialised in the healthcare sector. That development has gone hand in hand with our own development. Our need for support changed and Open Line always had an appropriate response. The CEO of Open Line acknowledges that this has led to a partnership relationship with Maastro Clinic rather than a client/provider relationship: developing new functionalities together to achieve more.”
Understanding what a disruption means
Such a partnership benefits from mutual understanding and domain knowledge, which is why Open Line's IT professionals were introduced to the work floor at Maastro Clinic. It is important that technicians do not just report a 'Priority 3' when there is a malfunction, but understand that in that case a patient’s treatment is at risk or even ceases. The vendor neutral archive (VNA) is therefore not a medical-data backup or archive for Maastro Clinic, but is used actively and in real time to continuously adjust treatments based on treatment results. Examples include patient characteristics that change during treatment, such as body weight. No data means no effective treatment and that can be life-threatening. A separate SLA has therefore been prepared for the VNA.
A partnership also develops gradually and has several facets. Although Open Line was happy to take on new projects from the outset and specialised more and more in the process, Maastro Clinic could initially not benefit from a healthcare-related track record of Open Line. There were no references and no off-the-shelf solutions in this respect. In addition, frequent contact is essential. Soeren: “Open Line is a party that is close at hand. Size does matter: there are short lines of communication, you can contact the chief executive directly, you have a close relationship with each other. We are in contact almost every day. Talking about mainstream services, but also about projects and each other's strategy: are we both going in the same direction? When it comes to longer-term cooperation, a form of lock-in is created in any event. This is not the same for every lot, but you have to manage the whole thing actively. In addition to the bond of trust that has been built up, a certain dependency develops.”
The impact of IT
Jacobs: “IT has had an increasing impact on our organisation, both in terms of business processes and our budget. We map out our risks carefully and have our choices evaluated and tested, including the extent to which we can or cannot mitigate those risks. We then discuss them in detail internally. How do you avoid over-dependence in a partnership? What is the quality of your contract management? How do you shape the relationship further? It is essential to regularly consider what the interest is regarding the other party – how important are you to each other – because equality can also change.”
More IT yes, becoming an IT company no
As the knowledge embedded in its own custom software is among Maastro’s crown jewels, the organisation has invested in its own development capacity to rewrite the code. In other words: the software is being updated. “Although software and data will play an increasing role in our processes, we are and will remain an organisation focused on treating people, we will not become an IT company.” We are also too small for that purpose, says Jacobs. Soeren: “That makes you vulnerable, whereas I strive for robustness and redundancy and high availability. But developing MVPs is something we intend to keep on board, with or without partners. However, we are not quick enough and too small for their eventual development.”
About MAASTRO Clinic
Maastro Clinic is an institute where cancer patients in particular are treated by means of radiotherapy. The independent clinic, which frequently collaborates with Maastricht University Hospital and Maastricht University, has six state-of-the-art linear accelerators ( radiotherapy devices), type Varian® TrueBeamTMen and a Mevion Hyperscan PBS Proton Accelerator. Maastro Clinic is located in Maastricht next to the MUMC+ academic hospital.