Experience 2: Ground zero is everywhere: Immediate expert diagnosis anywhere, anytime

A new kind of CDC, the Centers for Health Expansion (CHE), was developed as a strategic healthcare firewall, ready to respond to disease threats instantly. Beyond today’s CDC, which operates physically out of Atlanta, Georgia, the CHE is always on, with digital presences everywhere, ready to provide universal threat awareness, analysis and strategic protection from potential health crises.

Ebola mutates like other viruses. In fact, by 2014 there were already four variants of the Ebola virus, with genetic divergences as great as 45 percent. In 2025 a fifth variant of Ebola appeared. Immune to all vaccines, it was as contagious and deadly as a media headline writer’s dreams.

Without warning, the CHE’s newest unexpected challenge had arrived.


To Nurse Kate Sweeney, an intake nurse at the University of Wisconsin Student Health Center in Madison, Wisconsin, it was just another busy day until Kani Imara arrived. Kani was a young African man, running a high fever and vomiting, obviously in severe pain.

Alarmed, Nurse Sweeney called in Dr. Diane Mayhew, the senior doctor on duty. Dr. Mayhew learned that Kani had recently arrived from Africa and was acutely ill.

“Hmm, this could be an African infectious disease,” Dr. Mayhew said to Nurse Sweeney. “Let’s check with the CHE.”

Dr. Mayhew turned to the examining room’s wall screen and Focused the clinic’s Immediate Response Shared Space, which provided instantly available resources. She Activated its continuous connection to the CHE’s “First Response Team” in Atlanta, Georgia.

Susan Leck, a CHE medical threat assessment specialist, instantly appeared live on the wall screen in the examination room at the University of Wisconsin’s Student Health Center. Ms. Leck was life-size in a simulated 3-D parallax view, looking like she sat in the same room with them, separated by only a sheet of glass. Her name, title and location was displayed next to her head by the Shared Space‘s recognition system, as was Dr. Mayhew‘s next to her image in front of Ms. Leck. Recognition was immediate because this used the Shared Spaces’ short list of members, with access to each person’s biometric profile.

“Hello, Dr. Mayhew,” Ms. Leck said, immediately addressing her by name. “How can the CHE help?”

As the United States’ healthcare firewall, by 2025 the CHE was leading the building of a DMI, a Digital Medical Infrastructure. Its “Shared Planetary Life Spaces” provided continuous connections to related groups of people, places, systems, services, online tools, data and other resources. They all remained Inactive while connected. A Presence System maintained readiness to Activate any of them instantly when needed.

The CHE ran multiple Shared Spaces for first responders, infectious diseases, chronic conditions, infection control, strategic medical supplies and more. Because anyone and anything could be immediately added from one Shared Space to another, it was as if the CHE had turned the nation’s medical infrastructure into a universal digital resource, both focused and able to deliver all its digital services instantly in real-time, everywhere.

In the big picture, today’s digital child was maturing. A new kind of Digital Earth platform gave every organization and person the world’s combined abilities at their fingertips. During use Active Knowledge protocols were auto-displayed so everyone always knew how to rise to the top. Shared Spaces added continuous connections so people and organizations worked together instantly. New opportunities for greatness were everywhere, a new norm for everyone’s life.

Dr. Mayhew quickly updated the CHE’s Ms. Leck. She checked the CHE’s Active Knowledge protocol for this first response, learning Kani had just arrived from Liberia to start classes at the University of Wisconsin the following week. Kani had been rescued as a young teen from child labor on a cocoa plantation in Cote d‘lvoire, smuggled into Liberia and educated in a farming community, where he grew into a local leader who helped stop child trafficking and forced labor on cocoa plantations. After he attended several international conferences as a speaker, a Swiss-based child trafficking organization hired him for their Monrovia office. Now they were sending him to the University of Wisconsin for a year of training in an international leadership development program on human rights.

Suddenly that wasn’t as important as saving Kani’s life. Ms. Leck told Dr. Mayhew a new mutated strain of Ebola had developed in Liberia, and it was resistant to the Ebola vaccine developed in 2015. Since this might be its first case in the United States, she immediately displayed the CHE‘s Active Knowledge protocol for resistant Ebola, so they could start applying it.

Ms. Leck Focused the CHE’s Infectious Diseases Shared Space. She Activated its top Ebola epidemiologist, told him there was an emergency, and added him to the “First Response” Shared Space. She introduced Dr. Richard Chester, in Boston, at Harvard Medical School. Dr. Chester was studying the new resistant Ebola strain in Liberia using both personal visits and digital presence in Medical Treatment Shared Spaces.

“Give me a minute,” Dr. Chester said, using a tablet, “and I’ll switch to my desk.”

Dr. Mayhew blended Kani Imara’s medical record into the Shared Space background. When Dr. Chester sat down in front of his PC he was recognized and his digital environment restored. Because the First Responder Shared Space was on his tablet when he put it down, the same Shared Space was displayed automatically on his PC screen, with Kani’s medical records blended into its background.

In Madison, Wisconsin, Dr. Chester’s new PC-acquired image was displayed at Kani Imara’s medical examination. He took over and guided the medical examination of Kani Imara. He recognized the symptoms and told them this was probably the new strain of Ebola. He said the patient needs an IV to replenish lost fluids first.

Ms. Leck immediately Activated two more “First Responder” specialists while Dr. Mayhew Activated Suresh Sharma, the clinic’s administrator. He looked over the exam room, saw the patient resting after vomiting, and the CHE participants on screen with their names and titles next to each of them.

“Sorry to interrupt, Suresh,” Dr. Mayhew said. “We have a likely Ebola patient in an exam room. This is a deadly disease. We talked to Susan Leck from the CHE and she brought in Dr. Richard Chester from Harvard. He’s an Ebola specialist and he’s guiding our diagnosis and treatment.”

“Ebola!” Suresh exclaimed. “We’re just a student health center. What should we do next?”

“We’ll get the patient and your clinic through this,” Dr. Chester said.

Ms. Leck introduced herself and the two CHE specialists she had just Activated in this First Response Shared Space. “Tom Figuera is a CHE Personal Protective Equipment specialist, and he will help you put on protective suits immediately. Li Min is our Infection Control specialist.”

Ms. Leck checked the Active Knowledge protocol which listed the steps on the side of the screen. “We’re ready to go. Dr. Chester will help treat the patient. You need to work with Tom on getting your staff in PPE right away; that’s Personal Protective Equipment. Then Li will help your staff isolate this exam room, evacuate the clinic, and sanitize it to prevent infections. I’ll start the geo-containment to stop this before it spreads — so far we found and isolated this outbreak’s first source.” (22; see Example 3, “Geo-containing the spread of contagious disease”)

On the screen each person’s names and information floated next to their live images. It showed Ms. Leck was in Atlanta, Dr. Chester in Boston, Tom in Philadelphia, Li in San Diego and Suresh Sharma using a tablet near a nurse’s station in the Madison, Wisconsin clinic.

Each person’s live video was blended into an on-screen group which auto-sized and lit everyone so it looked as if they were meeting in a single room. They muted their audio to this main group and started working together individually, hearing the audio from just the person they worked with.

Tom helped Suresh get them the best available PPE immediately, then he turned to Dr. Mayhew and Nurse Sweeney and helped them put it on correctly.

Next, Dr. Chester took over and guided the treatment and medical examination of Kani Imara. They were triple gloved so he put on triple gloves and took time to show Dr. Mayhew and Nurse Sweeney the best technique to find a vein, draw blood and start an IV — without sticking themselves with a needle. With his guidance they safely obtained blood samples to do a DNA analysis of this strain of Ebola, to learn more about this new vaccine resistant strain.

Simultaneously, Li Min helped the clinic focus on infection control. They captured personal contact information from all the patients there, their friends with them, and staff, then evacuated the clinic. Then he organized the staff in sanitizing the university’s student health center, so it could reopen as soon as possible.

Ms. Leck also Focused the CHE Protocol Improvement Shared Space, and Activated Jim Hutton who was in Atlanta at the CHE’s headquarters. She added Jim as an observer, so that team could immediately see the current Ebola discovery protocol during use. All CHE “First Response” sessions were recorded, so he had a complete record of the steps followed and the patient‘s condition. If a better procedure was possible, Protocol Improvement would update that Active Knowledge protocol so the next Ebola incident would apply the best steps.

Then she Activated a CHE Communications specialist, Lisa Gerber in Washington, DC. In 2025 the arrival of Ebola and the evacuation of the University of Wisconsin’s Student Health Center would spark an immediate surge of online attention on Ebola, the people present at its discovery, and every step the CHE took to handle it. These would be Lisa’s focus, and she had the CHE Shared Spaces, team and event recording to handle the coming torrent.

By 2025 Ebola was being redefined as E-bola by a new digital medical infrastructure. Simultaneously, by 2025 their new digital coordination capabilities were equally swift and effective, (see Example 3) and its abilities to treat infectious diseases at their sources were being transformed globally. 


Transformations from Today

In 2025 an appropriate, immediately responsive medical task force is delivered by Focusing the CHE’s “First Responders Shared Space” and Activating each of its continuous connections as needed.

Like many infectious diseases, Ebola doesn’t show symptoms immediately so it can surface anywhere. Because healthy people incubate Ebola for up to 21 days before they appear ill, they can travel around the world while looking and testing normal. The same is true for other infectious diseases like malaria (31) and cholera (32), which people can carry to new places before they become ill. Infectious diseases are endemic in various cities, slums and rural areas worldwide. As people live and work together, many jobs and services cross class lines and neighborhoods, including airports and planes that fly people everywhere.

Today’s CDC attempts to prepare the entire nation’s medical system to deal with infectious diseases like Ebola. Everyone must be trained to recognize Ebola and each other disease, then know how to use the current CDC protocol to treat it. The scarce resources of hospitals, community health centers, doctor’s offices, and health workers — in a wide range of work, transportation, home or public locations — are spent getting everyone ready to become “ground zero” if Ebola or another epidemic arrives.

We simply don’t have the resources and time to do this for all 215 human infectious diseases that have produced over 12,000 outbreaks in the last 33 years alone. (7)

Set ahead in 2025, “Ground Zero is Everywhere” illustrates a continuously connected Digital Earth whose fictional CHE provides immediately accessible presence, and a real-time digital medical firewall against potential medical crises.

A persistent network of Shared Spaces lets the CHE provide this by using a new Digital Medical Infrastructure. Its “First Responders” Shared Space provides access to multiple specialists, with substitution rules when a specific expert is not available. Related Shared Spaces, like Infection Control, provide deeper capabilities in narrow domains that are required by many other Shared Spaces.

In this Digital Earth pre-deployed Shared Spaces let the CHE respond to threats like Ebola with leading medical specialists, guide crucial skills like putting on PPE (Personal Protective Equipment) correctly or sanitizing the medical facility, and immediately use best practices like the Active Knowledge Ebola protocol. A Shared Space includes “always on” people, systems, services, locations and resources appropriate for a situation or process — but they are Inactive until needed. At the moment each part is needed, that continuous connections is instantly Activated.

As each person uses and switches devices, a Presence System recognizes and follows them. The experience of Shared Spaces is continuous and uninterrupted. Each person controls their presence. They can limit or expand their availability in each Shared Space. When an organization like the CHE controls presence, stored rules let them determine how presence works, and how substitution works when there is an immediate need and someone is not available.

People and digital elements can be added from one Shared Space to another. For a narrow example the fictional Dr. Chester, is both an Ebola “First Responder” and a leading specialist in the Ebola Shared Space (see Example 6). Conversely, a single person can be associated immediately with multiple Shared Spaces, like the fictional Li Min whose work in the Infection Control Shared Space associates her with many medical Shared Spaces.

The screens in Shared Spaces are dynamically constructed using real-time computer graphics blending. Like CGI in the movies, any combination of people, data, images, systems, locations and resources could be blended on the screen. This overcomes the incompatibilities between different data sources because one or more participants can see the constructed view. Any of them could change it, too. The result is multiple customizable online environments that reflect what users and organizations want displayed, rather than the limited view from the physical world.

For the technology industry, a pervasive digital environment turns today’s competitive devices into commodity gateways. The actual device and brand are eclipsed whether one uses a smart phone, tablet, PC/Laptop, wearable, connected television or another kind of connected device. Once a powerful and attractive Digital Earth is built, the world of unique, expensive devices will diminish.

Today’s medical infrastructure is similarly impacted. The advent of a build once, run everywhere medical infrastructure will transform high-cost medical services that are based on building and supporting expensive medical facilities, skills and capabilities everywhere throughout societies.

Each succeeding example will make that clearer. Together these will illustrate how a Digital Earth could deliver high quality medical care that includes universal availability, immediate responses, rapid advances and lower costs.