̽��ֱ�� of Cambridge - Centre for International Manufacturing

Take your medicine: how research into supply chains will help you take care of yourself

lw355 — Wed, 14 Jun 2017 15:20:27 +0000

“Like many people of my age, I have to take pills morning and night. I’m pretty good at taking them in the evenings, mainly because my wife makes me! But, left to my own devices in the mornings, I only remember to take them perhaps one day out of four,” says Dr Jag Srai.

“Wouldn’t it be fantastic if smartphones could remind patients, capture use and track activity, blood pressure, sugar level, and so on? And if, at the same time, their GP could see this data and call them in if there’s a problem?”

He explains that upwards of 30% of prescribed drugs are not taken by patients and, in the case of respiratory drugs, where application is more intricate, 70% are not taken as directed. ̽��ֱ��numbers vary depending on the type of condition being treated but they are disarmingly high across the board. This has consequences, and not only for the patient. ̽��ֱ��cost to the taxpayer of drugs that are not being used is considerable and reduces the pot of money available for patient care.

“In a world of scarce resources this in itself seems incredibly wasteful. But there are other reasons to be concerned,” adds Srai, who is Head of the Institute for Manufacturing (IfM)’s Centre for International Manufacturing. “Around 50% of patients taking antibiotics don’t complete the course. ̽��ֱ��consequences of this are potentially catastrophic as infections become increasingly resistant to drug treatment. And drugs contain active ingredients which, when disposed of inappropriately, end up as contaminants in our water supply.”

Tackling the thorny problem of patient compliance is just one aspect of the pharmaceutical industry that Srai and his team at the IfM are looking to revolutionise. They are working with other universities and major UK pharmaceutical companies AstraZeneca and GSK to make improvements across the whole supply chain, from how a pill is made to the moment it’s swallowed by the patient.

Advances in genetics and biochemistry are helping us move towards a much more tailored approach to medicine, focused on more targeted or niche patient populations, and ultimately the development of bespoke treatments to meet individual patient needs. ̽��ֱ��implications for how the pharmaceutical industry manufactures its medicines and gets them to the patient are clearly immense.

Most pharmaceutical manufacturing still takes place in huge factory complexes, where large volumes of chemicals are processed in a series of ‘batch-processing’ steps, and often a dozen or more are required to produce the final oral dose tablet. Developing new drugs is an expensive business and so big pharma companies hope for a ‘blockbuster’ drug – a medicine that could be used to treat a very common condition, such as asthma or high blood pressure, and which can be manufactured in large quantities.

But, says Srai, the manufacture of these blockbuster drugs is becoming a thing of the past. ̽��ֱ��batch process is costly, inefficient and makes less sense when producing medicines in small volumes.

New ‘continuous’ manufacturing processes mean that drugs can be made in a more flow-through model, requiring fewer steps in the manufacturing process, and in volumes better aligned with market demand. In the case of small volume manufacture, this technology breakthrough can support the move towards more personalised medicine.

“Combine this with the way in which digital technologies are transforming supply chains – through flexible production and automation, using sensors to track location, quality and authenticity, and big data analytics on consumption patterns – and it’s clear that the pharmaceutical industry is on the cusp of a huge change,” adds Srai.

Recognising this, and to make sure they harness the value these advances in science and technology can deliver, pharmaceutical companies are working together in a number of ‘pre-competitive forums’.

̽��ֱ��IfM team is playing a key part in two major related UK initiatives: the Continuous Manufacturing and Crystallisation (CMAC) Future Manufacturing Research Hub based at Strathclyde ̽��ֱ��, funded by £10m from the Engineering and Physical Sciences Research Council and a further £31m from industry; and REMEDIES, a £23m UK pharmaceutical supply-chain sector project, jointly funded by government and industry.

CMAC is focused on the move to continuous manufacturing and REMEDIES on developing new clinical and commercial supply chains. Srai’s team is leading the work on mapping the existing supply chains for different types of treatment, and modelling what the future might look like.

“We can envisage a future in which for some medicines, production is no longer a highly centralised large-scale batch operation but one where manufacturing is more about continuous processing, more distributed in nature, smaller scale and closer to the point of consumption.”

Asked how local this can become, Srai adds: “In some instances we are already able to ‘print’ tablet medicines on demand, and we are now exploring whether this might take place at more local production/distribution sites, or at the local pharmacy or even in our own homes. Of course, some critical hurdles still need to be overcome, not least in terms of assuring product quality at multiple sites and establishing appropriate regulatory regimes.

“New technologies are also opening up other possibilities in the way that patients receive healthcare. Wearable and smartphone apps could be feeding diagnostic and health information to our doctors – be they human or (with the advances in artificial intelligence) robot – who would assess our symptoms remotely. We may change our consultation habits completely and only go to the doctor for very specific types of treatment. Indeed, in the UK today, trials suggest some 30% of GP visits are unnecessary.”

As part of the REMEDIES project, the IfM team has been exploring the possibilities presented by technologies that are available now such as Quick Response (QR) codes that can be scanned by mobile apps on our smart phones – and how they can help ensure that patients are taking their medicine.

“A relatively easy thing to do with packaging is to use it as an information source for patients. For example, packs of pills come with a small leaflet that hardly anybody reads. If we want to help patients adhere to their treatment regimes, can we support them by giving them this plus more useful information in a more accessible electronic format?”

̽��ֱ��REMEDIES team is working on a mobile phone app that will allow patients to read the instructions on their phone (in a font size and language of their choice) or listen to some explanatory audio or watch a video. “This is simple, readily available technology that could have a significant impact on compliance,” says Srai.

̽��ֱ��potential for exploiting data to deliver bespoke healthcare in the future is enormous. With smart packaging, smartphones and wearable devices, information can become increasingly dynamic and interactive. Indicators such as time, location – even mood – can affect whether and how drugs are taken; and data such as blood pressure and pulse can show the effect they have on the patient.

“As in the world of e-commerce, we are at the early stages of understanding how this consumer and patient data can inform the supply chain,” says Srai. “But we can now contemplate scenarios in certain therapeutic areas, in which each dose a patient takes is fully optimised for the here and now, and manufactured continuously, or even printed on demand.”

And if the patient forgets to take it, they will, if they choose, be reminded to do so by a very insistent app.

Inset image: Read more about research on future therapeutics in Research Horizons magazine.

Researchers are working with pharmaceutical companies to make improvements across the whole supply chain, from how a pill is made to the moment it is swallowed by the patient.

We are already able to ‘print’ tablet medicines on demand, and we are now exploring whether this might take place at more local sites, or at the local pharmacy or even in our own homes.

Jag Srai

Kate Russell

Keep taking the tablets

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How bright is your digital future?

Anonymous — Wed, 18 Jan 2017 08:35:54 +0000

̽��ֱ��combination of new technologies, IT infrastructures and data analytics holds out an alluring possibility of a world in which the end-to-end supply chain is utterly transformed – highly connected, flexible, efficient, resilient and truly responsive to customer needs. Each of those attributes sounds attractively incremental but put them together and you have a completely new way of doing business and one in which customers are not just on the receiving end of a product or service but are central to it.

A good example of this is the pharmaceutical sector. As part of the REMEDIES project, we are working with the major players in the UK pharmaceutical supply chain to address some of the challenges they face, such as tackling the hundreds of days’ of inventory sitting in the supply chain and the vast quantities of waste caused by patients not taking the drugs they are prescribed.

Using digital technologies and data-rich systems to make the pharmaceutical supply chain much more efficient is one thing but we are also mapping an entirely new business model in which drugs can be manufactured to order – possibly at the local pharmacy. Not only would this meet a patient’s individual medical needs, but the consumption and effects of those drugs can be continuously monitored to help doctors better support their patients.

A brave new world, in other words, of personalised medicine enabled by digital manufacturing processes, digital infrastructures and lots of data. But realising this vision of a digital future remains elusive, particularly for the largest global businesses.

Many of these companies recognise the need to digitalise aspects of their supply chain, often in response to particular challenges. They may, for example, as in the pharmaceutical sector, have a pressing need to solve the intransigent inventory management issues that bedevil many supply chains. They may have an issue with quality and see digitalisation as the best way to ensure their products are of a consistently high quality and their provenance is traceable.

Or they may be losing competitive advantage through poor customer service and see a digital agenda as a way of regaining market share, possibly while supporting their ambitions to reduce environmental impact.

But developing an end-to-end digital supply chain involves a major transformation both at a conceptual level and in execution. And while thought leaders and change agents within big companies may see the prize, CEOs and shareholders will be much more cautious given the levels of investment and organisation-wide disruption it entails. This is particularly the case for the global giants with a history of merger and acquisition (M&A) and an array of legacy systems to integrate. Even without the complication of M&A, all large companies have to organise themselves into manageable structures, which have a natural tendency to turn into silos and hence become obstacles to organisational change.

There is also the wider question of a lack of digital skills and attitudes across the board – at senior and middle management levels as well as within day-to-day factory operations. Companies may be able to see the opportunity, acquire the technology and capture the data but a shortage of both skills and mindset presents a significant barrier.

One of the challenges with the digital supply chain vision is the sheer scale and ambition of it. At the Centre for International Manufacturing, we have begun to conceptualise what a digital supply chain might look like and break it down into key areas to help companies understand the key ways in which digitalisation can impact on their organisation. We have been doing this by talking to companies both individually and as a non-competitive group.

Having identified the key areas, we have been developing ‘maturity models’ against which companies can benchmark their current performance, identify where the greatest opportunities lie and start to think about where to prioritise their efforts.

Factory design and production processes

Digital developments in factory design and production processes underpin the extended supply chain. ̽��ֱ��flexible factory is an important concept in this rapidly moving environment: how can you design and configure a factory for technologies which you don’t yet know? In this context, factories need to be modular and reconfigurable. One of the questions our framework helps companies consider is this: it is relatively straightforward to design a state-of-the-art, highly flexible plug-and-play factory – but is it cost-effective? Is it where companies will be able to create and capture most value?

Making the most of data

Some companies are already very good at gathering product and customer data but the challenge is how to integrate that data and use it to make better decisions about, for example, product lifecycle management, sales forecasting and designing products and services in response to customer needs. Data ownership is fast becoming an important issue in the supply chain and service delivery context. When partners are involved, who owns and can access the data is a critical question. Data sharing and connectivity also raises the question of open source versus ‘black box’ and developing common international data standards across sectors. In this area we must also consider the resilience of these digital supply chains and understand the cyber security challenges they may present.

Flexibility versus connectivity

One of the conceptual and practical challenges for organisations is whether to build monolithic, enterprise-wide systems that can connect supply chains. Clearly, for many companies – particularly those with a history of M&A – it would require a huge act of organisational will, not to mention significant investment, to move to a common platform. And, would doing so actually deliver a sufficiently flexible and reconfigurable solution? Instead, companies are talking about developing a ‘digital backbone’ that can interface with other systems to provide more networked and flexible approaches to optimising the end-to-end supply chain. And this digital backbone is more than an IT system – it should embody the critical touch points and interfaces between organisations as well as the data architectures and analytics. It also signifies a cultural shift to digital.

̽��ֱ��last leg

Using web-based systems to fulfil orders and manage the complexity of last-mile logistics is something that we have seen business-to-consumer companies do with impressive levels of sophistication and achieve corresponding levels of competitive advantage. For many large manufacturers there is still work to be done in developing systems that can support product delivery to multiple points of sale and ultimately direct to the end customer. But the opportunities are clear and create a virtuous circle. By delivering better customer service you not only attract new customers (and retain the old ones) but you also get access to better customer data which in turn can improve both the product and the service you offer. There are also many efficiencies to be had from digitalising this last leg of the supply chain though better stock management and reduced transport costs.

Towards the digital supply chain

By breaking down the digital supply chain into distinct but connected scenarios against which companies can measure their performance and aspirations, we believe we have created a powerful framework that will help them develop their digital supply chain capabilities. ̽��ֱ��scenarios help to clarify thinking and develop a strategic approach to digitalisation which is both deliverable and will create maximum value for the company.

̽��ֱ��next step is to put the strategy into action.

First published in IfM Review.

Dr Jag Srai, Head of the Centre for International Manufacturing at Cambridge's Institute for Manufacturing, and colleagues are developing new ways to help companies embrace the challenges and opportunities of digitalising the extended supply chain. Here, he provides a glimpse of this digital future.

A brave new world of personalised medicine enabled by digital manufacturing processes, digital infrastructures and lots of data

Jag Srai

Jacqueline ter Haar

pharmaceuticals

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Keeping the supply chain flowing

lw355 — Tue, 06 Oct 2015 15:47:22 +0000

A typical supply chain can be a vast, sprawling network of producers, suppliers, ‘super middlemen’, retailers and consumers that connect, for instance, a piece of mined aluminium with a finished car, or a field of wheat with a loaf of bread on the table.

Dr Jag Srai and the team he heads in the Centre for International Manufacturing like nothing better than a complex, multi-faceted supply chain, because within the connections lies a vital source of competitive advantage. Companies that can more optimally ‘configure’ this complex network have the opportunity not only to improve their business but also to do so sustainably in an otherwise resource-hungry and wasteful world.

“Many supply chains today have developed over time, a consequence of often short-term tactical decisions or ill-considered mergers and acquisitions,” he explains. “There may be large distances between component supply and the end product, delays in sharing information along the chain, or an excessive fragmentation of activities.

“Within little more than a generation, the traditional model of a vertically integrated firm, which has most of its component and final product in-house, has become fragmented. Today, for manufacturing a typical consumer electronics product, dozens of firms in as many countries might be involved in its manufacture, with activities dispersed among narrowly focused companies distributed across developed and emerging economies.”

Srai’s team has been mapping these global networks across multiple sectors, developing novel tools for their visualisation and for identifying opportunities to reconfigure them to meet demand more effectively.

Of particular focus has been a comparison of the food and pharmaceutical process industries, and the assembly power houses of aeronautical and automotive industries, in both the UK and India.

“Manufacturing is a top priority in both countries,” explains Professor Sir Mike Gregory, former Head of the Institute for Manufacturing, where the Centre is based. “In the UK, the government has placed manufacturing at the heart of plans for economic recovery. And in India, the government launched the ‘Make in India’ initiative in 2014 with the aim of transforming the country into a major global manufacturing hub and generating millions of new jobs.”

̽��ֱ��project is funded by the UK’s Engineering and Physical Sciences Research Council and the Indian Department of Science and Technology. It began a year ago but follows a previous study in which the team created a set of representations of the UK food supply chain for dairy, fruit and vegetables, and staple foods. It was painstakingly collated from industrial reports, literature reviews and first-hand case studies, as well as interviews with key industrial players.

̽��ֱ��resulting map provides a fascinating insight into the dynamics of networks that many consumers are unaware of – such as the one that links a cow on a dairy farm to a pint of milk on a UK doorstep (a seven-step process, as it turns out).

Crucially, it also identifies how new trends are being driven by an increasing demand from consumers to know where their food is coming from and for cheaper, own-brand labels. “Organisations that are able to align these complex networks with their own strategic aims have an opportunity to set themselves apart from their competitors,” explains Srai.

One of the researchers’ main interests is how maps such as this can be used to foster a more sustainable approach to manufacturing, as Dr Mukesh Kumar explains: “Food security, for instance, is a global challenge as populations continue to grow, yet 30–40% of food in the UK is currently wasted, mostly at the retail and consumer end of the chain.”

Working with their collaborators in India, the team has now generated comparable maps of the Indian food supply chain. ̽��ֱ��comparison could help each to explore the key differences and identify how multinationals from one country looking to do business in the other might need to adapt a supply chain to work best.

“ ̽��ֱ��UK food retail chain is dominated by a few large, organised retailers who control 73% of UK grocery sales, and as a result exert considerable influence over upstream partners in the chain, whereas in India this type of organised retail accounts for only 12% of sales,” Kumar explains.

“But the largest difference is where the wastage happens. In India, most wastage occurs at the early stages of the supply chain, with tonnes of fruit and vegetables perishing due to poor handling and storage facilities and lack of cold chain infrastructure.”

According to estimates by the United Nation’s Food and Agriculture Organization, each year about 40% of India’s fresh fruit and vegetables rot before reaching consumers’ plates, as does an amount of wheat almost equal to Australia’s total annual production.

“Supply chains that link the UK and India incur waste up- and downstream. ̽��ֱ��figures are quite scary – you sometimes wonder how anything ends up on a plate!” observes Srai.

He highlights how crucial it has been to work closely with Indian researchers, industry and policy makers, helped by funding through the UK India Education and Research Initiative: “We have chosen partners in India who complement our skills. It’s like a supply chain in action! It has seen a continuous stream of collaborations emerging out of this, none of which would have been possible without this project.”

For instance, researchers at the Indian Institute of Technology Ropar and the Indian Institute of Management Lucknow have been looking at how simulation and modelling of operations could be used to flag up sustainability challenges.

“Our Centre’s research on ‘network mapping’ tools and close links to industry have meant that we have provided methods and industry contacts to our partners, while leveraging their specialist skills in the specific areas that we require. We have also taken the combined output to inform our wider work in the ̽��ֱ��’s Strategic Research Initiative on Global Food Security,” says Srai.

“Technology, supply chains and the way markets and regions develop become interesting change agents. I believe that our research network will be able to anticipate these changes,” he adds. “It’s only by understanding a company’s overall global supply network – a ‘whole system’ approach – that it’s possible to appreciate the opportunities and the benefits that can emerge for doing things better, wherever you are in the world.”

Inset image: Distribution centre (Nick Saltmarsh).

In this age of rapid and escalating change, what can businesses do to flourish? Take a look at their supply chains, say researchers in the Centre for International Manufacturing, based on their research in the UK and India.

Supply chains that link the UK and India incur waste up- and downstream – you sometimes wonder how anything ends up on a plate!

Jag Srai

Neil Palmer (CIAT)

Increasing the efficiency of food supply chains can decrease wastage

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