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 authentication for remote patient monitoring withwireless medical sensor networks

There is broad consensus that remote health monitoring will benefit all stakeholders in the healthcare system and that it has the potential to save billions of dollars. Among the major concerns that are preventing the patients from widely adopting this technology are data privacy and security. Wireless Medical Sensor Networks (MSNs) are the building blocks for remote health monitoring systems. This paper helps to identify the most challenging security issues in the existing authentication protocols for remote patient monitoring and presents a lightweight public-key-based authentication protocol for MSNs. In MSNs, the nodes are classified into sensors that report measurements about the human body and actuators that receive commands from the medical staff and perform actions. Authenticating these commands is a critical security issue, as any alteration may lead to serious consequences. The proposed protocol is based on the Rabin authentication algorithm, which is modified in this paper to improve its signature signing process, making it suitable for delay-sensitive MSN applications. To prove the efficiency of the Rabin algorithm, we implemented the algorithm with different hardware settings using Tmote Sky motes and also programmed the algorithm on an FPGA to evaluate its design and performance. Furthermore, the proposed protocol is implemented and tested using the MIRACL (Multiprecision Integer and Rational Arithmetic C/C++) library. The results show that secure, direct, instant and authenticated commands can be delivered from the medical staff to the MSN nodes. © 2016 by the authors; licensee MDPI, Basel, Switzerland

Secure Authentication for Remote Patient Monitoring with Wireless Medical Sensor Networks.

There is broad consensus that remote health monitoring will benefit all stakeholders in the healthcare system and that it has the potential to save billions of dollars. Among the major concerns that are preventing the patients from widely adopting this technology are data privacy and security. Wireless Medical Sensor Networks (MSNs) are the building blocks for remote health monitoring systems. This paper helps to identify the most challenging security issues in the existing authentication protocols for remote patient monitoring and presents a lightweight public-key-based authentication protocol for MSNs. In MSNs, the nodes are classified into sensors that report measurements about the human body and actuators that receive commands from the medical staff and perform actions. Authenticating these commands is a critical security issue, as any alteration may lead to serious consequences. The proposed protocol is based on the Rabin authentication algorithm, which is modified in this paper to improve its signature signing process, making it suitable for delay-sensitive MSN applications. To prove the efficiency of the Rabin algorithm, we implemented the algorithm with different hardware settings using Tmote Sky motes and also programmed the algorithm on an FPGA to evaluate its design and performance. Furthermore, the proposed protocol is implemented and tested using the MIRACL (Multiprecision Integer and Rational Arithmetic C/C++) library. The results show that secure, direct, instant and authenticated commands can be delivered from the medical staff to the MSN nodes

Wireless body area network revisited

Rapid growth of wireless body area networks (WBANs) technology allowed the fast and secured acquisition as well as exchange of vast amount of data information in diversified fields. WBANs intend to simplify and improve the speed, accuracy, and reliability of communica-tions from sensors (interior motors) placed on and/or close to the human body, reducing the healthcare cost remarkably. However, the secu-rity of sensitive data transfer using WBANs and subsequent protection from adversaries attack is a major issue. Depending on the types of applications, small and high sensitive sensors having several nodes obtained from invasive/non-invasive micro- and nano- technology can be installed on the human body to capture useful information. Lately, the use of micro-electro-mechanical systems (MEMS) and integrated circuits in wireless communications (WCs) became widespread because of their low-power operation, intelligence, accuracy, and miniaturi-zation. IEEE 802.15.6 and 802.15.4j standards have already been set to specifically regulate the medical networks and WBANs. In this view, present communication provides an all-inclusive overview of the past development, recent progress, challenges and future trends of security technology related to WBANs

A Survey on Wireless Security: Technical Challenges, Recent Advances and Future Trends

This paper examines the security vulnerabilities and threats imposed by the inherent open nature of wireless communications and to devise efficient defense mechanisms for improving the wireless network security. We first summarize the security requirements of wireless networks, including their authenticity, confidentiality, integrity and availability issues. Next, a comprehensive overview of security attacks encountered in wireless networks is presented in view of the network protocol architecture, where the potential security threats are discussed at each protocol layer. We also provide a survey of the existing security protocols and algorithms that are adopted in the existing wireless network standards, such as the Bluetooth, Wi-Fi, WiMAX, and the long-term evolution (LTE) systems. Then, we discuss the state-of-the-art in physical-layer security, which is an emerging technique of securing the open communications environment against eavesdropping attacks at the physical layer. We also introduce the family of various jamming attacks and their counter-measures, including the constant jammer, intermittent jammer, reactive jammer, adaptive jammer and intelligent jammer. Additionally, we discuss the integration of physical-layer security into existing authentication and cryptography mechanisms for further securing wireless networks. Finally, some technical challenges which remain unresolved at the time of writing are summarized and the future trends in wireless security are discussed.Comment: 36 pages. Accepted to Appear in Proceedings of the IEEE, 201

e-SAFE: Secure, Efficient and Forensics-Enabled Access to Implantable Medical Devices

To facilitate monitoring and management, modern Implantable Medical Devices (IMDs) are often equipped with wireless capabilities, which raise the risk of malicious access to IMDs. Although schemes are proposed to secure the IMD access, some issues are still open. First, pre-sharing a long-term key between a patient's IMD and a doctor's programmer is vulnerable since once the doctor's programmer is compromised, all of her patients suffer; establishing a temporary key by leveraging proximity gets rid of pre-shared keys, but as the approach lacks real authentication, it can be exploited by nearby adversaries or through man-in-the-middle attacks. Second, while prolonging the lifetime of IMDs is one of the most important design goals, few schemes explore to lower the communication and computation overhead all at once. Finally, how to safely record the commands issued by doctors for the purpose of forensics, which can be the last measure to protect the patients' rights, is commonly omitted in the existing literature. Motivated by these important yet open problems, we propose an innovative scheme e-SAFE, which significantly improves security and safety, reduces the communication overhead and enables IMD-access forensics. We present a novel lightweight compressive sensing based encryption algorithm to encrypt and compress the IMD data simultaneously, reducing the data transmission overhead by over 50% while ensuring high data confidentiality and usability. Furthermore, we provide a suite of protocols regarding device pairing, dual-factor authentication, and accountability-enabled access. The security analysis and performance evaluation show the validity and efficiency of the proposed scheme