It is time for the biopsychosocialtech model

Technologies of all types have become a fundamental part of our day-to-day lives. They may be invisible, remote, or directly controlled by us, and they are everywhere. Our basic body functions can be diagnosed, treated, and even replaced by new and advanced technologies. Our personal day-to-day activities and social relationships and connectivity are now also greatly impacted by technologies. Thus, the case can be made that it is time to expand the biopsychosocial approach or model to the biopsychosocialtech model. The biopsychosocial approach is based on general systems theory and was first articulated by George L. Engel, M.D., at the University of Rochester Medical Centre in Rochester, NY [1]. He stated that treating only body functions and structures is inadequate for understanding a person’s illness and that the most successful interventions are those that are based on the dynamic interaction of the biological, psychological (emotional/behavioural) and social (and environmental) factors impacting the individual, expanded upon in Table 1 to include technological. The biopsychosocial approach continues to be fundamental today in guiding patient treatment and medical education at the University of Rochester Medical Centre [2], as well as many other programmes around the world, and is the foundation for the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) [3]. The four components of the biopsychosocialtech model are not only dynamically interrelated, but they influence and reconstitute one another over time and can affect many different levels of functioning, from cellular to organ system to person to family to society in an individually unique way. Technology alone can also reconstitute biological functions and systems, personal factors and social interactions and involvement. Thus, the choice to use, avoid, or reject a technology has implications for all the elements of the biopsychosocial model. Figure 1 is an admittedly imperfect depiction of four interrelated spheres (biological, psychological, social and technological) and how they change over time and reconstitute one another. The photos of the spheres were taken from screen shots from Dimensions Ep.4 – The fourth dimension II, a French project that makes educational movies about mathematics, focussing on spatial geometry [4]. Each sphere or component is independent and comprised of elements that also evolve, reconfigure and change over time and are affected by the others in varying ways and degrees. In 2020, as the world contends with the Coronavirus Disease 2019 (COVID-19), we are witnessing the exploding role of technology in diagnosis and treatment. For example, advances in endoscopes and laboratory and diagnostic tools such as CRISPR for gene editing, as well as continued developments in medical and assistive technologies, have greatly impacted treatment options, decisions and outcomes. Thanks to advances in sensing and monitoring technologies, more people can stay in their homes and live independently. Nowadays a person can control door locks, room temperature, window blinds, and a variety of appliances with a smartphone or hands-free speaker controlled by voice, such as Amazon’s Echo. Robotic devices can do chores and provided some routine services to individuals thereby freeing caregivers for more sophisticated tasks. The easy availability of home delivery services in well populated areas adds another layer of support for the person in the home. Mobile health and telerehabilitation services can remotely monitor a person’s vital signs and allow for home-based health management for those in less densely populated areas. An example of this in AT was a process developed in Ireland where trained individuals went to people’s homes and conducted personalized assessments of needs, priorities, barriers and facilitators to create an individualized intervention plan. Professional consultation was achieved by transmission of assessment data and the plan to the appropriate professionals in Dublin. [5]. Lessons learned in the field of assistive technology over time include some important fundamental concerns and considerations such as: