It’s easy to assume where you work is, well, where you work.   But Steve’s comment made me reflect on just what he and his students had seen.  What is it about our company that is so attractive for top-flight engineers to come and work with us when they could work at any blue-chip around the world?   I narrowed it down to eight key factors:

Variety.  Bright engineers, like all bright minds, crave stimulation.  Each year we work on more than 300 projects so most engineers work on at least two different jobs in any 12 months.  And because we work across a range of sectors, projects are naturally diverse, employing multi-disciplinary teams to solve the problem in hand.    As one of our engineers, Gemma, comments in her recent interview for Cambridge Business Magazine (P21-22)   in one year she’s used her experience as a mechanical engineer to work on projects as diverse as medical technology development through to coffee machines.

Challenge.  Despite the diversity of our work, one common seam runs throughout all our activities; and that’s the technical challenge.  Because of the way we are set up, we rarely get asked to do the mundane or seemingly easy; instead we thrive on the difficult or the never done before problems that we get asked to solve every day.  It is, after all, what we’re good at.

People. As well as working on interesting projects, Cambridge Consultants has developed a reputation as a hot spot for interesting and able people.  In part that becomes self fulfilling, because the type of engineers who work for us value the ability to work alongside colleagues they like and whose insight, technical capability and expertise they respect.  Working with like-minded colleagues who you can share ideas with and learn from across a range of market sectors and engineering disciplines is seen as a real plus.

Culture.  The company’s roots stretch back to the early ‘60s and part of that ‘hippy culture’ is still in our DNA today.  Whilst you won’t find anyone sporting a kaftan and peace symbol, we have retained a genuine community feel which starts with senior management and permeates throughout.  The company genuinely cares about the welfare of its people and this manifests itself in all manner of ways… from the canteen which serves free hot and cold meals every day through to the 360-degree review process for each member of staff.

Track record.   Both Cambridges – the one in the UK and the one next to Boston in Massachusetts – have a rich history of technology and no shortage of hi-tech companies based around them.   Cambridge Consultants is often referred to as one of the two founders of the UK’s Cambridge Phenomenon (although we do have offices in the other Cambridge too!).

Performance. In a recent interview by Business Weekly, our CEO, Dr Brian Moon, went on record as announcing that the company is currently enjoying unparalleled growth and has had the best performance in its 50 year history.   These achievements, and our continual innovation for clients, has led us to win numerous awards including two prestigious Queen’s Awards for Enterprise.

Responsibility & opportunity. Part of the thing about employing exceptional people is that we give them responsibility quickly.  The company has proven processes and systems to manage fast-track product development, but ultimately it comes down to people to make them happen.  That kind of trust is empowering.   That same ethos means we are a great place to work if you passionately believe in a technology or a market where you think you can make a difference.    If you believe you can build something – and you can convince others of your conviction – then we are just the type of company to put a product development team around you and give you the chance to show your entrepreneurial skills.  It’s exactly the way that all our successful business campaigns were started; by people with a passion to achieve.

The opportunity to become a millionaire.   While most of our staff can spend a whole career developing new products and technology, some choose to take the entrepreneurial skills they have learnt and to create new companies from our spin-out function.   We’ve created more than 20 new companies in our history.  Many, such as CSR, Domino, and Xaar, have gone on to be fully listed on the stock market, whilst others have achieved high-value trade sales.  It’s created dozens of millionaires in the local region and created more than 3,000 technology jobs.

Anyone for a job in innovative product development?

A number of recent reports have highlighted the potential vulnerability of medical implants to hacker attack. This is a risk that must be taken seriously and managed in innovative medical product development when wireless links are made fundamental to the safe and effective provision of a life critical therapy.

It is undoubtedly possible to produce radio linked devices for many applications that are vulnerable to attack and vulnerability tends to increase for battery powered devices because some cryptographic and authentication functions use significant energy. Of course with a medical device, even if the device had sophisticated protection against such attack, if a persistent attack merely drained the battery this could have a life threatening effect in itself.

It is however giving up far too easily to say that because only a small energy source can be afforded that therefore no authentication or cryptographic protection can be provided. It is for the designers of such an implant to ensure that its operation remains safe under reasonable attck of this kind. They need to take a system view not a component view to manage these risks successfully. These problems are not entirely new either as there are an increasing number of battery powered radio linked devices that handle data of economic value that have to be proof against such attacks. They typically wake up seldom, do something secure using quasi-asymmetric techniques to minimise radio vulnerability. As time goes by silicon processes get smaller and the associated voltage and current reduces leading to a substantial reduction in energy usage for the same digital processing power so this will mean that for the same energy source, more processing power will be available for resilience against such hacker attacks as technology progresses. Another example of a system approach to this threat has been reported by researchers from MIT where a separate jamming system is used to provide resilience against hacker attack.

Studies show that, whilst the concept of using a standard asthma inhaler (known in drug delivery circles as a metered dose inhaler, or MDI), is relatively straightforward, in practice only 25% of the population actually use it correctly.  Put another way, the drug you think you are taking to treat your condition doesn’t actually get delivered to the parts of the lung where it does any good.   In turn, someone ends up in an A&E department every seven minutes in the UK alone and, according to estimates from Asthma UK, 75% of these admissions are avoidable and as many as 90% of deaths from asthma are preventable.  The figures in the United States are no better, where 5,000 people visit the emergency room due to asthma every day.

With the prevalence of asthma growing around the globe, already affecting around 235 million, we think it’s a problem that needs addressing.

The latest generation of inhalers is, of course, a great improvement on the standard MDI, which has been with us since the 1950s.  Medical technology development since then has made many leaps and bound.  Whilst this new generation is much more effective at delivering life-saving drug effectively, there remains the problem that the vast majority of asthma sufferers still receive the standard MDI to treat their condition.  So what can be done to help them?

We think the answer lies in proper training for this potentially life-saving device.  If you are given any training today, it is mainly performed through observation and, as the results show, it’s generally ineffective.  So we set about working out whether relatively simple technology could make a difference.

One of the things that sets Cambridge Consultants apart from other product developers is we have all the engineering skills you need under one roof to undertake truly innovative product development.  By combining specialists in human factors, user interface design, mechanical and electronics engineering, wireless communication, software development and drug delivery, we were able to quickly create the T-Haler concept.

The results were, frankly, stunning.

After just three minutes of training using a computer game and a specially modified training inhaler, we were able to improve correct usage from around one in five, to more than three in five.  That’s not bad for just three minutes, and without the need for a medical professional to be present.

The technology is relatively low cost to deploy, the inhaler could be simply posted or picked up from a pharmacy when you get your medicine, and we estimate the training inhaler could be made in volume for less than $5 a unit.  Just as easily, the software could be delivered directly to your smartphone, so that you can keep an eye on how you are doing from time to time.  We even think the cost of providing such a training aide would easily be outweighed by the massive cost savings that correct device usage would generate for already stretched healthcare providers.   We now wait to see how the healthcare industry reacts and whether anyone is prepared to take this concept further.

A short video of the T-Haler concept can be found on here.  Until training video’s like T-haler are widely available, great advice is available on the web if you want to try and improve on your inhaler use technique.  A good starting point can be found on the Asthma UK website.

Where should be drawing the line in innovation between valuable services and data privacy? Google has created a stir by changing its privacy rules and there are allegations that the new rules breach EU privacy rules. Of course, Google is an immensely profitable company that provides many services “free” to consumers, which it is able to do by using consumer information. In a sense the new privacy policy is a logical extension of what we as consumers have accepted – if I’m happy for Google to use my information to optimise advertising within gmail, youtube or search, does it really change the position from my viewpoint if the same data is shared between search, gmail and youtube? Consumers are creating an ever larger digital footprint through Facebook, Twitter, Google etc and particularly the young are more and more indifferent to these privacy issues.

But these kind of information systems are becoming more pervasive not less. The same governments who are up in arms about this issue are actively working on creating Smart Meter and Grid systems which have a number of worthwhile aims in terms of increasing energy efficiency and improving energy use behaviour. Are you happy with that? You are – well what about if the signature of your energy usage is used to push recommendations on how you could reduce the energy usage / carbon foot print of your house. What if that service was paid for by advertising of energy efficient products based on your signature? Still okay?

How about if the system was sufficiently vulnerable that a hacker could turn off your energy or tell that your house was unoccupied and burgle it? Getting nervous now? Well we are and hence we’re bringing our system expertise to bear on this issue, combining what we know about system design, counter terrorism , wireless communications and smart metering. There’s more on this point in my previous blog .

Beyond this there are additional pressures on costs of healthcare and home care. The industry is facing increasing pressure to reduce the overall cost of the healthcare burden on society and one way to do this is to start thinking about the patient throughout their lifespan and offering holistic services rather than just medical technology or drugs that effect specific conditions. Clearly as a global innovative product development company, with a specialist division in medical technology, we have a keen interest in these changes. We conducted a workshop on Consumer Health and Wellness, that concluded that conventional consumer and medical companies were vulnerable to new entrants whose services were based on mining digital information. It’s relatively easy to imagine “lifestyle” apps that monitor vital statistics and activity level and push recommendations on taking exercise or remembering to take your medication as part of this wider trend. But how about if the service is funded by pushing advertising of relevant products based on this mined data? Whilst the potential benefits of treating the patient as an individual is obvious, what are the privacy issues around such a system if it were to be hacked or misused?

Ultimately, society has to decide whether it wants all the benefits a connected system could offer, balanced against the risks to us as individuals should our data become vulnerable. Opinions will differ from country to country and from culture to culture, yet consumers around the world – almost irrespective of political boundaries have got used to very low cost digital services but these are expensive capabilities to put in place. Without the advertising revenue model, you are left with direct consumer funding or government funding. So do you want to own and control your data or are you willing to compromise this in the interests of obtaining low cost digital services? And if you are how do you want the Corporate behomoths that are the inevitable product of mass adopted digital services to be regulated with respect to your data? At the moment many of us tick a box saying we have accepted all sorts of use of our data without even reading what we are signing up to. There are real benefits, what is the balance of what you want to pay in money and data?

And it’s this language that has traditionally lead to different responses to that individuals needs, whether it’s the way we listen to music or the drug regime we are prescribed.  In turn, of course, this influences they way people design and develop the products we use.

With the advent of patient monitoring solutions, reform of healthcare, and increasing significance of medication adherence, we are starting to see the medical device community looking again at what patients really are ie, people, and the way they want their treatments to fit into their lives, if they are going to correctly use the medical devices they are given.

Human Factors Engineering (HF) is the approach used to incorporate user considerations into medical device design. User Experience (U_x) design, typically called upon for consumer products, is a more holistic approach that supports the overall intended user experience. Our experts in human factors engineering, however, have come up with a term that combines the best of both of those, and are calling it ‘Patient Experience’ or Px design for short.  In principle it encompasses the safety and rigor of the HFE discipline, whilst combining it with the broader lens of a U_x approach.

We believe that the team necessary to execute an effective Px development is highly multi-disciplinary. Human factors engineers, industrial designers and graphic designers, engineers and marketers must share common understanding of the core values of the desired experience and fiercely protect this vision throughout the entire development cycle.

Px encourages pharmaceutical companies to switch from a drug or molecule-driven design perspective to a system or service design perspective. Medical devices can become, through a Px approach, the mere physical embodiments of a broader compliance and outcome-based service. With changes in the healthcare landscape and the dwindling security of patented molecules, ensuring improved health outcomes and maintaining brand loyalty by building a B2C relationship with patients is becoming increasingly critical to the financial success of companies providing the treatment therapies.

If this subject has caught your interest, you’ll find a more comprehensive explanation by Melanie Turieo in her recent article published by European Medical Device Technology magazine.

Look at the past decade and you’d be hard pushed not to have noticed the arrival of the ‘coffee phenomena’; something that has spread to nearly every major high street.  Before the arrival of Starbucks and the like, getting a decent cup of coffee in Britain or the US was a fairly hit and miss experience. Even if you could find one, it probably wasn’t presented with the flair and panache of the true Italian barista; and in part this is what has fueled this retail ‘explosion’.  For just couple of pounds, dollars or Euros you can get a minute or two’s theatre whilst someone bustles around a great big steam snorting machine that yields a rather excellent (if not slightly addictive) drink.

Now wind the clock forward to just the last five years or so, and the second global trend is the downturn in the global economy. One thing we’ve noticed is that consumers are shying away from making major financial investments with their cash, and instead are preferring to treat themselves on ‘one of life’s little luxuries’. Or, as the Brisbane Times reports, the ‘Lipstick indicator’ effect, where economists noted how the sale of small luxuries can increase during uncertain economic times, such as the demand for lipstick during World War II.

Cambridge Consultant’s Consumer group, noted these two trends – and with over 30 innovative beverage dispense projects under their belt – wondered why tea drinks got such a rough deal on the high street in comparison to their coffee drinking colleagues.  As one of our principal engineers, Edward Brunner commented, “Tea drinkers stand in line in a retail outlet and watch as their coffee-drinking fellow customers are treated to a personal ‘barista experience’. Meanwhile they are presented with a mug of hot water and a soggy bag on a string.”   So the challenge was on, and shortly afterwards, the TeaTotal prototype was born.

By identifying the independent variables that impact flavour, and how to separately manipulate them to deliver each consumer’s ideal cup, the Consumer team then set about developing a prototype machine that incorporated this functionality, whilst at the same time keeping a watchful eye on the retailer’s need to keep a high rate of throughput.  TeaTotal not only allows you to personalise the taste of your tea, but it is also capable of making the perfect cup in just two minutes; that’s around half the time it’s believed you’ll need to get the same quality drink from a tea pot; not that we have anything against the tea pot you understand… an excellent thing, however, it’s just rarely spotted on today’s high street retail environment, and we are all for ‘Save the teapot’ campaign, that got launched on the same day as our TeaTotal press release was issued.

If you’d like to watch the lab built prototype in action click here and scroll to the bottom of the press release

There is clear analogy between the issues here. Cloud based solutions offer great scaleability and we can see an unstoppable economic trend in the growth of cloud based services because it offers a more efficient way of allocating computing resources to need. However, this is a big change and some stakeholders won’t like it in principle. IT departments that get their status and rewards from keeping bespoke systems running will not naturally embrace this. However, cash strapped services may well see the benefits in not having to tie up capital in expensive IT hardware and software, but instead pay for use. However, even if the cost model of adopting the ‘the Cloud’ stack up, the arguments that will be deployed to maintain the status quo will more likely centre around data ownership, confidentiality and security.

There is an assumption that in house resources are managed and controlled in a way that external services are not. Whilst there certainly can be differences,in reality,  it’s hard to argue that be-spoke government systems are more secure. There has been a succession of examples in the UK of the loss or disclosure of confidential data from such systems. And there have also been examples in the private sector such as the Sony Play Station data theft. I think this shows that there isn’t an in principle advantage of adopting one approach over the other, but what it’s really about is deploying the right security protocols. But even here there are important differences to consider. Is providing remote meter reading and other smart metering functions, a more security critical application than banking over the internet? Banks accept that they will suffer some degree of fraud by providing internet banking with all its asociated beenfits to millions of customers. Whether smart metering is equivalent depends on other key decisions. There are clearly analogous “money fraud” risks inherent in remote meter reading over the air or the internet. But there are additional risks if the smart metering communications incorporates a remote “switch off” capability. In principle, this creates a hacker vulnerability to shut down energy to subsets of the grid and if this happened in cold weather or to crirical infrastructure it could cause deaths or serious injury. It also creates a risk that shut-offs arising from the mistakes of the back office mistakes of the energy companies could cause the same hazards. So different kinds of secure system requirements would be needed to manage this kind of risk compared to one where the risk is purely economic. Further before embarking on life critical systems such as this, the Government should consider the danger that a be-spoke long life time system will become more vulnerable as time progresses and may lack the investment to respond to evolving threats.

Ultimately I suspect the economic drivers will win. The resources are no longer there to commission these bespoke systems that don’t deliver, when piggy backing off commercial developments can transform the investment required.

In the later half of 2011, Cambridge Consultants ran a workshop in Boston, MA, with senior delegates from some of the worlds leading blue chips in health and consumer, such as adidas, Robert Bosch Healthcare, Unilever, and Philips Healthcare, as well as some ambitious start up companies such as MC10 and Innovative Sleep Solutions.  This select group came together to debate the topic of ‘The business of health and wellness; engaging consumers and making money’.

Now you may have expected this group to come up with the usual group of apps and gadgets that often get talked about in the media (and our own Rachel Harker talked about these in her blog back in July last year), and it is true to say that there is an ever growing demand for these types of products.  However, for me, the biggest finding to have come out of this workshop was a belief that the established players in the consumer goods and medical sectors face the threat of losing their market position to a whole new generation of algorithm-driven companies as the two sectors emerge.

According to Duncan Smith, who heads up Cambridge Consultants product and system development division, the report explores two key points of view around successful revenue models: one, that profit will be driven by reimbursement for solutions demonstrating a reduction in healthcare costs; two, that success will lie in directly targeting consumers and engaging them in improving their own health and well-being. Both views come together around the prediction that healthcare will become increasingly personalised, moving away from treatment to lifestyle management. Through the innovative use of health data, managed by complex algorithms (not dissimilar to those already used by companies such Google and eBay in their own spaces), the scene is potentially set for a new – dominant – name in the industry to emerge, a company that trawls health data and uses it to help people live healthier lives.

Duncan, along with colleagues who are product development experts in areas such as wireless communications and consumer products, will all be attending CES next week, where they will be exploring how the findings of this report will impact the consumer products market directly over the next five years.  Details on how to get in touch with the team at CES can be found here.

As I see it, there are a number of inherent problems in the way things are currently done that almost guarantee the outcome outlined above. Amongst these are:

• Mixed agendas, for example, the best value solution versus supporting the British economy versus supporting innovation and complying with treaty obligations such as EU free trade rules versus benefits in marginal seats
• A total lack of understanding of the cost of delay. Most governments and bureaucracies get criticised in the media for projects that go wrong, paradoxically they get little criticism for doing nothing and yet this always comes with cost escalation
• An ability to always see the limitations in commercial off the shelf solutions whilst being blind to the limitations of custom solutions. There’s a strange psychology of looking backwards criticising custom solutions specified by government and yet looking forwards always choosing yet another custom solution
• A lack of technology understanding in government leading to an inability to understand the cost drivers of “requirements”. This is characterised by committees adding a few requirements oblivious to the billions in cost being added
• The smaller projects tend to run better because the costs and benefits are more readily understood and the people running them have a better overall understanding without the drag from committees and hierarchies of management and approval

Successful innovation in the private sector is, in many ways, more conservative, but also much more effective. So when Apple created the iPAD it didn’t try to recreate everything; it uses WiFi, the internet, 3G. When Banks introduced computer banking, they used PCs and the internet. There’s usually a controlling mind rather than a levelling down committee. The project builds strongly on other R&D in the world and so remains up to date with time. In contrast, around much of the world, governments are currently engaged in SMART metering projects where they seem to think that recreating a government communications infra-structure is necessary rather than using the internet. The process involves large committees from government, energy companies and other stakeholders. Very little ever gets subtracted in this process, it intrinsically loads more costs as it crawls slowly into the future, whilst delaying decisions. In doing this they will create a single point to attack for cyber-criminals and hostile states and big databases that they will not succeed in keeping confidential. The cost of these projects is huge, typically 5-10 billion pounds and they’re only in the planning stage so they’ll probably cost much more. The assumed benefits are largely efficiency savings in the energy companies (relating to management of bad debts, automatic switching of consumers from credit to pay as you go tariffs) companies rather than reduction in carbon through energy efficiency. And wasn’t that meant to be the reason for introducing these meters in the first place (trouble is the carbon savings don’t justify the ticket price).

So whilst everyone is busy at this time of year making predictions of what 2012 will bring, I thought I would share some of mine:

• SMART Meter roll-out will not be achieved by 2020 – the government process continually delays the start without changing the end date
• The project costs will grow to more than £15 billion for the initial roll out
• And then the system will be obsolete in less than a decade and if the benefits are really required, the same order of cost will be expended again
• Consumers will probably hate the result when they see the impact on their privacy and the action the energy companies take against vulnerable people such as cutting their energy supply remotely (whether as a result of a dispute or a mistake)
• Carbon saving will be minimal (<3%); the country would achieve much more by spending the same amount on insulating buildings

I truly hope I’m proved wrong before it is too late. The stakes, after all, are high for us all.

The implicit trade-off is between parameters like convenience, vulnerability and upgradeability. Upgradeability allows convenient remote fixing of problems and addition of features – but the fact that the application can be changed creates an opportunity for someone to insert code that does something malicious. In the banking area, in many cases, the cost of on line fraud has been borne by financial instituitions rather than the individual so the individual has not had to bear the cost of the vulnerability so many consumers implicitly value the convenience and don’t have to ascribe much of a cost to the vulnerability.

But where is this all going? Connected systems can provide useability benefits in alomost every area, but at the cost of vulnerabilities. For instance, many countries have ambitious programs for smart metering. These include customer benefits like remote meter reading calling time on the typically inaccurate estimated bills that are often generated by the computers of the major energy companies. But in some countries the plans are more ambitious; so, for instance with a smart meter with a two way radio link, a remote command can be used to switch off the energy supply, which is perceived to be a benefit by the energy companies in managing difficult customers who can’t or won’t pay for their energy. This creates vulnerabilities like if a vulnerable person’s energy is switched off during winter, they might die of hyperthermia before the bureaucracy can decide to solve the problem and of course some of the energy companies are not renowned for sensitive and efficient customer service.

And this is not limited to finance and energy. Demographic changes mean that we are all living longer and surviving longer with chronic healthcare conditions. Mounting costs drive innovation in medical devices that enable them to provide self-administered therapies  and with the addition of connection, remote patient compliance monitoring. This can lead to security vulnerabilities that might endanger patient health or confidentiality.

From a technological point of view, it is possible to design extremely secure connected  systems, but that needs to be designed in at the outset not retrofitted. The vulnerabilities in these systems are almost always an arms race, where malicious attacks have to be responded to with upgrades. In general the higher the complexity, the more the vulnerabilities and too often systems are made over-complex and overlook the vulnerabilities created. So going back to the smart meter example – if you extend a remote meter reading provision through remote switch off and finally to a connected smart grid, you may be able to manage a greener infrastucture, but you may also open yourself to a hacker attack that takes down isolated or large parts of that supply network. Lack of clarity about the scope and reasons for the extension of scope tend to exaccerbate these vulnerabilities.