Security for networked smart healthcare systems: A systematic review

Background and Objectives Smart healthcare systems use technologies such as wearable devices, Internet of Medical Things and mobile internet technologies to dynamically access health information, connect patients to health professionals and health institutions, and to actively manage and respond intelligently to the medical ecosystem's needs. However, smart healthcare systems are affected by many challenges in their implementation and maintenance. Key among these are ensuring the security and privacy of patient health information. To address this challenge, several mitigation measures have been proposed and some have been implemented. Techniques that have been used include data encryption and biometric access. In addition, blockchain is an emerging security technology that is expected to address the security issues due to its distributed and decentralized architecture which is similar to that of smart healthcare systems. This study reviewed articles that identified security requirements and risks, proposed potential solutions, and explained the effectiveness of these solutions in addressing security problems in smart healthcare systems. Methods This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and was framed using the Problem, Intervention, Comparator, and Outcome (PICO) approach to investigate and analyse the concepts of interest. However, the comparator is not applicable because this review focuses on the security measures available and in this case no comparable solutions were considered since the concept of smart healthcare systems is an emerging one and there are therefore, no existing security solutions that have been used before. The search strategy involved the identification of studies from several databases including the Cumulative Index of Nursing and Allied Health Literature (CINAL), Scopus, PubMed, Web of Science, Medline, Excerpta Medical database (EMBASE), Ebscohost and the Cochrane Library for articles that focused on the security for smart healthcare systems. The selection process involved removing duplicate studies, and excluding studies after reading the titles, abstracts, and full texts. Studies whose records could not be retrieved using a predefined selection criterion for inclusion and exclusion were excluded. The remaining articles were then screened for eligibility. A data extraction form was used to capture details of the screened studies after reading the full text. Of the searched databases, only three yielded results when the search strategy was applied, i.e., Scopus, Web of science and Medline, giving a total of 1742 articles. 436 duplicate studies were removed. Of the remaining articles, 801 were excluded after reading the title, after which 342 after were excluded after reading the abstract, leaving 163, of which 4 studies could not be retrieved. 159 articles were therefore screened for eligibility after reading the full text. Of these, 14 studies were included for detailed review using the formulated research questions and the PICO framework. Each of the 14 included articles presented a description of a smart healthcare system and identified the security requirements, risks and solutions to mitigate the risks. Each article also summarized the effectiveness of the proposed security solution. Results The key security requirements reported were data confidentiality, integrity and availability of data within the system, with authorisation and authentication used to support these key security requirements. The identified security risks include loss of data confidentiality due to eavesdropping in wireless communication mediums, authentication vulnerabilities in user devices and storage servers, data fabrication and message modification attacks during transmission as well as while the data is at rest in databases and other storage devices. The proposed mitigation measures included the use of biometric accessing devices; data encryption for protecting the confidentiality and integrity of data; blockchain technology to address confidentiality, integrity, and availability of data; network slicing techniques to provide isolation of patient health data in 5G mobile systems; and multi-factor authentication when accessing IoT devices, servers, and other components of the smart healthcare systems. The effectiveness of the proposed solutions was demonstrated through their ability to provide a high level of data security in smart healthcare systems. For example, proposed encryption algorithms demonstrated better energy efficiency, and improved operational speed; reduced computational overhead, better scalability, efficiency in data processing, and better ease of deployment. Conclusion This systematic review has shown that the use of blockchain technology, biometrics (fingerprints), data encryption techniques, multifactor authentication and network slicing in the case of 5G smart healthcare systems has the potential to alleviate possible security risks in smart healthcare systems. The benefits of these solutions include a high level of security and privacy for Electronic Health Records (EHRs) systems; improved speed of data transaction without the need for a decentralized third party, enabled by the use of blockchain. However, the proposed solutions do not address data protection in cases where an intruder has already accessed the system. This may be potential avenues for further research and inquiry

Secure and Lightweight Authentication Protocols for Devices in Internet of Things

The Internet of Things (IoT) has become an intriguing trend worldwide as it allows any smart device with an IP address to participate in a highly immersive and connected environment that integrates physical, digital and social aspects of the user’s lives. The perpetual growth of IoT devices is resulting in less attention on the security side allowing attackers to find easy ways to exploit the devices. Hence, security is one of the important and challenging research areas in IoT. Furthermore, the resource-constrained nature of these devices results in poor performance when the traditional security protocols are used. In this thesis, we propose secure and lightweight authentication protocols for devices in IoT. A centralized network model is considered where the devices in the perception layer are mutually authenticated with the gateway of the system. A mutual authentication mechanism which uses symmetric key negotiation using Elliptic Curve Diffie-Hellman(ECDH) in the registration part of the protocol to protect the credentials of the devices and at the same time it minimizes the computation cost on the devices. At the end of the authentication, key agreement based on the symmetric key cryptography is established between the sensor devices and the gateway. Further, Elliptic Curve Integrated Encryption Scheme (ECIES) method is used to avoid the possibility of man-in-the-middle attack(MITM) in the registration phase of the previous protocol. An informal security verification of the protocols is presented which proves that they are resilient against perception layer attacks. The performance evaluation based on the metrics such as execution time, communication cost, computation cost of the protocol has been performed after the protocol is simulated in the Cooja simulator under Contiki OS environment. Further, the comparison results with the existing protocols show that the proposed system is lightweight as it provides low computation cost and better execution time

A survey on wireless body area networks: architecture, security challenges and research opportunities.

In the era of communication technologies, wireless healthcare networks enable innovative applications to enhance the quality of patients’ lives, provide useful monitoring tools for caregivers, and allows timely intervention. However, due to the sensitive information within the Wireless Body Area Networks (WBANs), insecure data violates the patients’ privacy and may consequently lead to improper medical diagnosis and/or treatment. Achieving a high level of security and privacy in WBAN involves various challenges due to its resource limitations and critical applications. In this paper, a comprehensive survey of the WBAN technology is provided, with a particular focus on the security and privacy concerns along with their countermeasures, followed by proposed research directions and open issues

An Authentication Protocol for Future Sensor Networks

Authentication is one of the essential security services in Wireless Sensor Networks (WSNs) for ensuring secure data sessions. Sensor node authentication ensures the confidentiality and validity of data collected by the sensor node, whereas user authentication guarantees that only legitimate users can access the sensor data. In a mobile WSN, sensor and user nodes move across the network and exchange data with multiple nodes, thus experiencing the authentication process multiple times. The integration of WSNs with Internet of Things (IoT) brings forth a new kind of WSN architecture along with stricter security requirements; for instance, a sensor node or a user node may need to establish multiple concurrent secure data sessions. With concurrent data sessions, the frequency of the re-authentication process increases in proportion to the number of concurrent connections, which makes the security issue even more challenging. The currently available authentication protocols were designed for the autonomous WSN and do not account for the above requirements. In this paper, we present a novel, lightweight and efficient key exchange and authentication protocol suite called the Secure Mobile Sensor Network (SMSN) Authentication Protocol. In the SMSN a mobile node goes through an initial authentication procedure and receives a re-authentication ticket from the base station. Later a mobile node can use this re-authentication ticket when establishing multiple data exchange sessions and/or when moving across the network. This scheme reduces the communication and computational complexity of the authentication process. We proved the strength of our protocol with rigorous security analysis and simulated the SMSN and previously proposed schemes in an automated protocol verifier tool. Finally, we compared the computational complexity and communication cost against well-known authentication protocols.Comment: This article is accepted for the publication in "Sensors" journal. 29 pages, 15 figure

Reliable Bidirectional Data Transfer Approach for the Internet of Secured Medical Things Using ZigBee Wireless Network

[EN] Nowadays, the Internet of Things (IoT) performs robust services for real-time applications in monitoring communication systems and generating meaningful information. The ZigBee devices offer low latency and manageable costs for wireless communication and support the process of physical data collection. Some biosensing systems comprise IoT-based ZigBee devices to monitor patient healthcare attributes and alert healthcare professionals for needed action. However, most of them still face unstable and frequent data interruption issues due to transmission service intrusions. Moreover, the medical data is publicly available using cloud services, and communicated through the smart devices to specialists for evaluation and disease diagnosis. Therefore, the applicable security analysis is another key factor for any medical system. This work proposed an approach for reliable network supervision with the internet of secured medical things using ZigBee networks for a smart healthcare system (RNM-SC). It aims to improve data systems with manageable congestion through load-balanced devices. Moreover, it also increases security performance in the presence of anomalies and offers data routing using the bidirectional heuristics technique. In addition, it deals with more realistic algorithm to associate only authorized devices and avoid the chances of compromising data. In the end, the communication between cloud and network applications is also protected from hostile actions, and only certified end-users can access the data. The proposed approach was tested and analyzed in Network Simulator (NS-3), and, compared to existing solutions, demonstrated significant and reliable performance improvements in terms of network throughput by 12%, energy consumption by 17%, packet drop ratio by 37%, end-to-end delay by 18%, routing complexity by 37%, and tampered packets by 37%.This research is supported by Artificial Intelligence & Data Analytics Lab (AIDA) CCIS Prince Sultan University, Riyadh, Saudi Arabia. Authors are thankful for the support.Rehman, A.; Haseeb, K.; Fati, SM.; Lloret, J.; Peñalver Herrero, ML. (2021). Reliable Bidirectional Data Transfer Approach for the Internet of Secured Medical Things Using ZigBee Wireless Network. Applied Sciences. 11(21):1-16. https://doi.org/10.3390/app11219947S116112

Towards end-to-end security in internet of things based healthcare

Healthcare IoT systems are distinguished in that they are designed to serve human beings, which primarily raises the requirements of security, privacy, and reliability. Such systems have to provide real-time notifications and responses concerning the status of patients. Physicians, patients, and other caregivers demand a reliable system in which the results are accurate and timely, and the service is reliable and secure. To guarantee these requirements, the smart components in the system require a secure and efficient end-to-end communication method between the end-points (e.g., patients, caregivers, and medical sensors) of a healthcare IoT system. The main challenge faced by the existing security solutions is a lack of secure end-to-end communication. This thesis addresses this challenge by presenting a novel end-to-end security solution enabling end-points to securely and efficiently communicate with each other. The proposed solution meets the security requirements of a wide range of healthcare IoT systems while minimizing the overall hardware overhead of end-to-end communication. End-to-end communication is enabled by the holistic integration of the following contributions. The first contribution is the implementation of two architectures for remote monitoring of bio-signals. The first architecture is based on a low power IEEE 802.15.4 protocol known as ZigBee. It consists of a set of sensor nodes to read data from various medical sensors, process the data, and send them wirelessly over ZigBee to a server node. The second architecture implements on an IP-based wireless sensor network, using IEEE 802.11 Wireless Local Area Network (WLAN). The system consists of a IEEE 802.11 based sensor module to access bio-signals from patients and send them over to a remote server. In both architectures, the server node collects the health data from several client nodes and updates a remote database. The remote webserver accesses the database and updates the webpage in real-time, which can be accessed remotely. The second contribution is a novel secure mutual authentication scheme for Radio Frequency Identification (RFID) implant systems. The proposed scheme relies on the elliptic curve cryptography and the D-Quark lightweight hash design. The scheme consists of three main phases: (1) reader authentication and verification, (2) tag identification, and (3) tag verification. We show that among the existing public-key crypto-systems, elliptic curve is the optimal choice due to its small key size as well as its efficiency in computations. The D-Quark lightweight hash design has been tailored for resource-constrained devices. The third contribution is proposing a low-latency and secure cryptographic keys generation approach based on Electrocardiogram (ECG) features. This is performed by taking advantage of the uniqueness and randomness properties of ECG's main features comprising of PR, RR, PP, QT, and ST intervals. This approach achieves low latency due to its reliance on reference-free ECG's main features that can be acquired in a short time. The approach is called Several ECG Features (SEF)-based cryptographic key generation. The fourth contribution is devising a novel secure and efficient end-to-end security scheme for mobility enabled healthcare IoT. The proposed scheme consists of: (1) a secure and efficient end-user authentication and authorization architecture based on the certificate based Datagram Transport Layer Security (DTLS) handshake protocol, (2) a secure end-to-end communication method based on DTLS session resumption, and (3) support for robust mobility based on interconnected smart gateways in the fog layer. Finally, the fifth and the last contribution is the analysis of the performance of the state-of-the-art end-to-end security solutions in healthcare IoT systems including our end-to-end security solution. In this regard, we first identify and present the essential requirements of robust security solutions for healthcare IoT systems. We then analyze the performance of the state-of-the-art end-to-end security solutions (including our scheme) by developing a prototype healthcare IoT system

Certificateless Algorithm for Body Sensor Network and Remote Medical Server Units Authentication over Public Wireless Channels

Wireless sensor networks process and exchange mission-critical data relating to patients’ health status. Obviously, any leakages of the sensed data can have serious consequences which can endanger the lives of patients. As such, there is need for strong security and privacy protection of the data in storage as well as the data in transit. Over the recent past, researchers have developed numerous security protocols based on digital signatures, advanced encryption standard, digital certificates and elliptic curve cryptography among other approaches. However, previous studies have shown the existence of many security and privacy gaps that can be exploited by attackers to cause some harm in these networks. In addition, some techniques such as digital certificates have high storage and computation complexities occasioned by certificate and public key management issues. In this paper, a certificateless algorithm is developed for authenticating the body sensors and remote medical server units. Security analysis has shown that it offers data privacy, secure session key agreement, untraceability and anonymity. It can also withstand typical wireless sensor networks attacks such as impersonation, packet replay and man-in-the-middle. On the other hand, it is demonstrated to have the least execution time and bandwidth requirements

An authentic-based privacy preservation protocol for smart e-healthcare systems in iot

© 2013 IEEE. Emerging technologies rapidly change the essential qualities of modern societies in terms of smart environments. To utilize the surrounding environment data, tiny sensing devices and smart gateways are highly involved. It has been used to collect and analyze the real-time data remotely in all Industrial Internet of Things (IIoT). Since the IIoT environment gathers and transmits the data over insecure public networks, a promising solution known as authentication and key agreement (AKA) is preferred to prevent illegal access. In the medical industry, the Internet of Medical Things (IoM) has become an expert application system. It is used to gather and analyze the physiological parameters of patients. To practically examine the medical sensor-nodes, which are imbedded in the patient\u27s body. It would in turn sense the patient medical information using smart portable devices. Since the patient information is so sensitive to reveal other than a medical professional, the security protection and privacy of medical data are becoming a challenging issue of the IoM. Thus, an anonymity-based user authentication protocol is preferred to resolve the privacy preservation issues in the IoM. In this paper, a Secure and Anonymous Biometric Based User Authentication Scheme (SAB-UAS) is proposed to ensure secure communication in healthcare applications. This paper also proves that an adversary cannot impersonate as a legitimate user to illegally access or revoke the smart handheld card. A formal analysis based on the random-oracle model and resource analysis is provided to show security and resource efficiencies in medical application systems. In addition, the proposed scheme takes a part of the performance analysis to show that it has high-security features to build smart healthcare application systems in the IoM. To this end, experimental analysis has been conducted for the analysis of network parameters using NS3 simulator. The collected results have shown superiority in terms of the packet delivery ratio, end-to-end delay, throughput rates, and routing overhead for the proposed SAB-UAS in comparison to other existing protocols