Cybersecurity in implantable medical devices

Mención Internacional en el título de doctorImplantable Medical Devices (IMDs) are electronic devices implanted within the body to treat a medical condition, monitor the state or improve the functioning of some body part, or just to provide the patient with a capability that he did not possess before [86]. Current examples of IMDs include pacemakers and defibrillators to monitor and treat cardiac conditions; neurostimulators for deep brain stimulation in cases such as epilepsy or Parkinson; drug delivery systems in the form of infusion pumps; and a variety of biosensors to acquire and process different biosignals. Some of the newest IMDs have started to incorporate numerous communication and networking functions—usually known as “telemetry”—, as well as increasingly more sophisticated computing capabilities. This has provided implants with more intelligence and patients with more autonomy, as medical personnel can access data and reconfigure the implant remotely (i.e., without the patient being physically present in medical facilities). Apart from a significant cost reduction, telemetry and computing capabilities also allow healthcare providers to constantly monitor the patient’s condition and to develop new diagnostic techniques based on an Intra Body Network (IBN) of medical devices [25, 26, 201]. Evolving from a mere electromechanical IMD to one with more advanced computing and communication capabilities has many benefits but also entails numerous security and privacy risks for the patient. The majority of such risks are relatively well known in classical computing scenarios, though in many respects their repercussions are far more critical in the case of implants. Attacks against an IMD can put at risk the safety of the patient who carries it, with fatal consequences in certain cases. Causing an intentional malfunction of an implant can lead to death and, as recognized by the U.S. Food and Drug Administration (FDA), such deliberate attacks could be far more difficult to detect than accidental ones [61]. Furthermore, these devices store and transmit very sensitive medical information that requires protection, as dictated by European (e.g., Directive 95/46/ECC) and U.S. (e.g., CFR 164.312) Directives [94, 204]. The wireless communication capabilities present in many modern IMDs are a major source of security risks, particularly while the patient is in open (i.e., non-medical) environments. To begin with, the implant becomes no longer “invisible”, as its presence could be remotely detected [48]. Furthermore, it facilitates the access to transmitted data by eavesdroppers who simply listen to the (insecure) channel [83]. This could result in a major privacy breach, as IMDs store sensitive information such as vital signals, diagnosed conditions, therapies, and a variety of personal data (e.g., birth date, name, and other medically relevant identifiers). A vulnerable communication channel also makes it easier to attack the implant in ways similar to those used against more common computing devices [118, 129, 156], i.e., by forging, altering, or replying previously captured messages [82]. This could potentially allow an adversary to monitor and modify the implant without necessarily being close to the victim [164]. In this regard, the concerns of former U.S. vice-president Dick Cheney constitute an excellent example: he had his Implantable Cardioverter Defibrillator (ICD) replaced by another without WiFi capability [219]. While there are still no known real-world incidents, several attacks on IMDs have been successfully demonstrated in the lab [83, 133, 143]. These attacks have shown how an adversary can disable or reprogram therapies on an ICD with wireless connectivity, and even inducing a shock state to the patient [65]. Other attacks deplete the battery and render the device inoperative [91], which often implies that the patient must undergo a surgical procedure to have the IMD replaced. Moreover, in the case of cardiac implants, they have a switch that can be turned off merely by applying a magnetic field [149]. The existence of this mechanism is motivated by the need to shield ICDs to electromagnetic fields, for instance when the patient undergoes cardiac surgery using electrocautery devices [47]. However, this could be easily exploited by an attacker, since activating such a primitive mechanism does not require any kind of authentication. In order to prevent attacks, it is imperative that the new generation of IMDs will be equipped with strong mechanisms guaranteeing basic security properties such as confidentiality, integrity, and availability. For example, mutual authentication between the IMD and medical personnel is essential, as both parties must be confident that the other end is who claims to be. In the case of the IMD, only commands coming from authenticated parties should be considered, while medical personnel should not trust any message claiming to come from the IMD unless sufficient guarantees are given. Preserving the confidentiality of the information stored in and transmitted by the IMD is another mandatory aspect. The device must implement appropriate security policies that restrict what entities can reconfigure the IMD or get access to the information stored in it, ensuring that only authorized operations are executed. Similarly, security mechanisms have to be implemented to protect the content of messages exchanged through an insecure wireless channel. Integrity protection is equally important to ensure that information has not been modified in transit. For example, if the information sent by the implant to the Programmer is altered, the doctor might make a wrong decision. Conversely, if a command sent to the implant is forged, modified, or simply contains errors, its execution could result in a compromise of the patient’s physical integrity. Technical security mechanisms should be incorporated in the design phase and complemented with appropriate legal and administrative measures. Current legislation is rather permissive in this regard, allowing the use of implants like ICDs that do not incorporate any security mechanisms. Regulatory authorities like the FDA in the U.S or the EMA (European Medicines Agency) in Europe should promote metrics and frameworks for assessing the security of IMDs. These assessments should be mandatory by law, requiring an adequate security level for an implant before approving its use. Moreover, both the security measures supported on each IMD and the security assessment results should be made public. Prudent engineering practices well known in the safety and security domains should be followed in the design of IMDs. If hardware errors are detected, it often entails a replacement of the implant, with the associated risks linked to a surgery. One of the main sources of failure when treating or monitoring a patient is precisely malfunctions of the device itself. These failures are known as “recalls” or “advisories”, and it is estimated that they affect around 2.6% of patients carrying an implant. Furthermore, the software running on the device should strictly support the functionalities required to perform the medical and operational tasks for what it was designed, and no more [66, 134, 213]. In Chapter 1, we present a survey of security and privacy issues in IMDs, discuss the most relevant mechanisms proposed to address these challenges, and analyze their suitability, advantages, and main drawbacks. In Chapter 2, we show how the use of highly compressed electrocardiogram (ECG) signals (only 24 coefficients of Hadamard Transform) is enough to unequivocally identify individuals with a high performance (classification accuracy of 97% and with identification system errors in the order of 10−2). In Chapter 3 we introduce a new Continuous Authentication scheme that, contrarily to previous works in this area, considers ECG signals as continuous data streams. The proposed ECG-based CA system is intended for real-time applications and is able to offer an accuracy up to 96%, with an almost perfect system performance (kappa statistic > 80%). In Chapter 4, we propose a distance bounding protocol to manage access control of IMDs: ACIMD. ACIMD combines two features namely identity verification (authentication) and proximity verification (distance checking). The authentication mechanism we developed conforms to the ISO/IEC 9798-2 standard and is performed using the whole ECG signal of a device holder, which is hardly replicable by a distant attacker. We evaluate the performance of ACIMD using ECG signals of 199 individuals over 24 hours, considering three adversary strategies. Results show that an accuracy of 87.07% in authentication can be achieved. Finally, in Chapter 5 we extract some conclusions and summarize the published works (i.e., scientific journals with high impact factor and prestigious international conferences).Los Dispositivos Médicos Implantables (DMIs) son dispositivos electrónicos implantados dentro del cuerpo para tratar una enfermedad, controlar el estado o mejorar el funcionamiento de alguna parte del cuerpo, o simplemente para proporcionar al paciente una capacidad que no poseía antes [86]. Ejemplos actuales de DMI incluyen marcapasos y desfibriladores para monitorear y tratar afecciones cardíacas; neuroestimuladores para la estimulación cerebral profunda en casos como la epilepsia o el Parkinson; sistemas de administración de fármacos en forma de bombas de infusión; y una variedad de biosensores para adquirir y procesar diferentes bioseñales. Los DMIs más modernos han comenzado a incorporar numerosas funciones de comunicación y redes (generalmente conocidas como telemetría) así como capacidades de computación cada vez más sofisticadas. Esto ha propiciado implantes con mayor inteligencia y pacientes con más autonomía, ya que el personal médico puede acceder a los datos y reconfigurar el implante de forma remota (es decir, sin que el paciente esté físicamente presente en las instalaciones médicas). Aparte de una importante reducción de costos, las capacidades de telemetría y cómputo también permiten a los profesionales de la atención médica monitorear constantemente la condición del paciente y desarrollar nuevas técnicas de diagnóstico basadas en una Intra Body Network (IBN) de dispositivos médicos [25, 26, 201]. Evolucionar desde un DMI electromecánico a uno con capacidades de cómputo y de comunicación más avanzadas tiene muchos beneficios pero también conlleva numerosos riesgos de seguridad y privacidad para el paciente. La mayoría de estos riesgos son relativamente bien conocidos en los escenarios clásicos de comunicaciones entre dispositivos, aunque en muchos aspectos sus repercusiones son mucho más críticas en el caso de los implantes. Los ataques contra un DMI pueden poner en riesgo la seguridad del paciente que lo porta, con consecuencias fatales en ciertos casos. Causar un mal funcionamiento intencionado en un implante puede causar la muerte y, tal como lo reconoce la Food and Drug Administration (FDA) de EE.UU, tales ataques deliberados podrían ser mucho más difíciles de detectar que los ataques accidentales [61]. Además, estos dispositivos almacenan y transmiten información médica muy delicada que requiere se protegida, según lo dictado por las directivas europeas (por ejemplo, la Directiva 95/46/ECC) y estadunidenses (por ejemplo, la Directiva CFR 164.312) [94, 204]. Si bien todavía no se conocen incidentes reales, se han demostrado con éxito varios ataques contra DMIs en el laboratorio [83, 133, 143]. Estos ataques han demostrado cómo un adversario puede desactivar o reprogramar terapias en un marcapasos con conectividad inalámbrica e incluso inducir un estado de shock al paciente [65]. Otros ataques agotan la batería y dejan al dispositivo inoperativo [91], lo que a menudo implica que el paciente deba someterse a un procedimiento quirúrgico para reemplazar la batería del DMI. Además, en el caso de los implantes cardíacos, tienen un interruptor cuya posición de desconexión se consigue simplemente aplicando un campo magnético intenso [149]. La existencia de este mecanismo está motivada por la necesidad de proteger a los DMIs frete a posibles campos electromagnéticos, por ejemplo, cuando el paciente se somete a una cirugía cardíaca usando dispositivos de electrocauterización [47]. Sin embargo, esto podría ser explotado fácilmente por un atacante, ya que la activación de dicho mecanismo primitivo no requiere ningún tipo de autenticación. Garantizar la confidencialidad de la información almacenada y transmitida por el DMI es otro aspecto obligatorio. El dispositivo debe implementar políticas de seguridad apropiadas que restrinjan qué entidades pueden reconfigurar el DMI o acceder a la información almacenada en él, asegurando que sólo se ejecuten las operaciones autorizadas. De la misma manera, mecanismos de seguridad deben ser implementados para proteger el contenido de los mensajes intercambiados a través de un canal inalámbrico no seguro. La protección de la integridad es igualmente importante para garantizar que la información no se haya modificado durante el tránsito. Por ejemplo, si la información enviada por el implante al programador se altera, el médico podría tomar una decisión equivocada. Por el contrario, si un comando enviado al implante se falsifica, modifica o simplemente contiene errores, su ejecución podría comprometer la integridad física del paciente. Los mecanismos de seguridad deberían incorporarse en la fase de diseño y complementarse con medidas legales y administrativas apropiadas. La legislación actual es bastante permisiva a este respecto, lo que permite el uso de implantes como marcapasos que no incorporen ningún mecanismo de seguridad. Las autoridades reguladoras como la FDA en los Estados Unidos o la EMA (Agencia Europea de Medicamentos) en Europa deberían promover métricas y marcos para evaluar la seguridad de los DMIs. Estas evaluaciones deberían ser obligatorias por ley, requiriendo un nivel de seguridad adecuado para un implante antes de aprobar su uso. Además, tanto las medidas de seguridad implementadas en cada DMI como los resultados de la evaluación de su seguridad deberían hacerse públicos. Buenas prácticas de ingeniería en los dominios de la protección y la seguridad deberían seguirse en el diseño de los DMIs. Si se detectan errores de hardware, a menudo esto implica un reemplazo del implante, con los riesgos asociados y vinculados a una cirugía. Una de las principales fuentes de fallo al tratar o monitorear a un paciente es precisamente el mal funcionamiento del dispositivo. Estos fallos se conocen como “retiradas”, y se estima que afectan a aproximadamente el 2,6 % de los pacientes que llevan un implante. Además, el software que se ejecuta en el dispositivo debe soportar estrictamente las funcionalidades requeridas para realizar las tareas médicas y operativas para las que fue diseñado, y no más [66, 134, 213]. En el Capítulo 1, presentamos un estado de la cuestión sobre cuestiones de seguridad y privacidad en DMIs, discutimos los mecanismos más relevantes propuestos para abordar estos desafíos y analizamos su idoneidad, ventajas y principales inconvenientes. En el Capítulo 2, mostramos cómo el uso de señales electrocardiográficas (ECGs) altamente comprimidas (sólo 24 coeficientes de la Transformada Hadamard) es suficiente para identificar inequívocamente individuos con un alto rendimiento (precisión de clasificación del 97% y errores del sistema de identificación del orden de 10−2). En el Capítulo 3 presentamos un nuevo esquema de Autenticación Continua (AC) que, contrariamente a los trabajos previos en esta área, considera las señales ECG como flujos de datos continuos. El sistema propuesto de AC basado en señales cardíacas está diseñado para aplicaciones en tiempo real y puede ofrecer una precisión de hasta el 96%, con un rendimiento del sistema casi perfecto (estadístico kappa > 80 %). En el Capítulo 4, proponemos un protocolo de verificación de la distancia para gestionar el control de acceso al DMI: ACIMD. ACIMD combina dos características, verificación de identidad (autenticación) y verificación de la proximidad (comprobación de la distancia). El mecanismo de autenticación es compatible con el estándar ISO/IEC 9798-2 y se realiza utilizando la señal ECG con todas sus ondas, lo cual es difícilmente replicable por un atacante que se encuentre distante. Hemos evaluado el rendimiento de ACIMD usando señales ECG de 199 individuos durante 24 horas, y hemos considerando tres estrategias posibles para el adversario. Los resultados muestran que se puede lograr una precisión del 87.07% en la au tenticación. Finalmente, en el Capítulo 5 extraemos algunas conclusiones y resumimos los trabajos publicados (es decir, revistas científicas con alto factor de impacto y conferencias internacionales prestigiosas).Programa Oficial de Doctorado en Ciencia y Tecnología InformáticaPresidente: Arturo Ribagorda Garnacho.- Secretario: Jorge Blasco Alís.- Vocal: Jesús García López de Lacall

Assentication: User Deauthentication and Lunchtime Attack Mitigation with Seated Posture Biometric

Biometric techniques are often used as an extra security factor in authenticating human users. Numerous biometrics have been proposed and evaluated, each with its own set of benefits and pitfalls. Static biometrics (such as fingerprints) are geared for discrete operation, to identify users, which typically involves some user burden. Meanwhile, behavioral biometrics (such as keystroke dynamics) are well suited for continuous, and sometimes more unobtrusive, operation. One important application domain for biometrics is deauthentication, a means of quickly detecting absence of a previously authenticated user and immediately terminating that user's active secure sessions. Deauthentication is crucial for mitigating so called Lunchtime Attacks, whereby an insider adversary takes over (before any inactivity timeout kicks in) authenticated state of a careless user who walks away from her computer. Motivated primarily by the need for an unobtrusive and continuous biometric to support effective deauthentication, we introduce PoPa, a new hybrid biometric based on a human user's seated posture pattern. PoPa captures a unique combination of physiological and behavioral traits. We describe a low cost fully functioning prototype that involves an office chair instrumented with 16 tiny pressure sensors. We also explore (via user experiments) how PoPa can be used in a typical workplace to provide continuous authentication (and deauthentication) of users. We experimentally assess viability of PoPa in terms of uniqueness by collecting and evaluating posture patterns of a cohort of users. Results show that PoPa exhibits very low false positive, and even lower false negative, rates. In particular, users can be identified with, on average, 91.0% accuracy. Finally, we compare pros and cons of PoPa with those of several prominent biometric based deauthentication techniques

Utilizing ECG Waveform Features as New Biometric Authentication Method

In this study, we are proposing a practical way for human identification based on a new biometric method. The new method is built on the use of the electrocardiogram (ECG) signal waveform features, which are produced from the process of acquiring electrical activities of the heart by using electrodes placed on the body. This process is launched over a period of time by using a recording device to read and store the ECG signal. On the contrary of other biometrics method like voice, fingerprint and iris scan, ECG signal cannot be copied or manipulated. The first operation for our system is to record a portion of 30 seconds out of whole ECG signal of a certain user in order to register it as user template in the system. Then the system will take 7 to 9 seconds in authenticating the template using template matching techniques. 44 subjects‟ raw ECG data were downloaded from Physionet website repository. We used a template matching technique for the authentication process and Linear SVM algorithm for the classification task. The accuracy rate was 97.2% for the authentication process and 98.6% for the classification task; with false acceptance rate 1.21%

Shallow Neural Network for Biometrics from the ECG-WATCH

Applications such as surveillance, banking and healthcare deal with sensitive data whose confidentiality and integrity depends on accurate human recognition. In this sense, the crucial mechanism for performing an effective access control is authentication, which unequivocally yields user identity. In 2018, just in North America, around 445K identity thefts have been denounced. The most adopted strategy for automatic identity recognition uses a secret for encrypting and decrypting the authentication information. This approach works very well until the secret is kept safe. Electrocardiograms (ECGs) can be exploited for biometric purposes because both the physiological and geometrical differences in each human heart correspond to uniqueness in the ECG morphology. Compared with classical biometric techniques, e.g. fingerprints, ECG-based methods can definitely be considered a more reliable and safer way for user authentication due to ECG inherent robustness to circumvention, obfuscation and replay attacks. In this paper, the ECG WATCH, a non-expensive wristwatch for recording ECGs anytime, anywhere, in just 10 s, is proposed for user authentication. The ECG WATCH acquisitions have been used to train a shallow neural network, which has reached a 99% classification accuracy and 100% intruder recognition rate

Reconhecimento de padrões baseado em compressão: um exemplo de biometria utilizando ECG

The amount of data being collected by sensors and smart devices that people use on their daily lives has been increasing at higher rates than ever before. That enables the possibility of using biomedical signals in several applications, with the aid of pattern recognition algorithms in several applications. In this thesis we investigate the usage of compression based methods to perform classification using one-dimensional signals. In order to test those methods, we use as testbed example, electrocardiographic (ECG) signals and the task biometric identification. First and foremost, we introduce the notion of Kolmogorov complexity and how it relates with compression methods. Then, we explain how can these methods be useful for pattern recognition, by exploring different compression-based measures, namely, the Normalized Relative Compression, a measure based on the relative similarity between strings. For this purpose, we present finite-context models and explain the theory behind a generalized version of those models, called the extended-alphabet finite-context models, a novel contribution. Since the testbed application for the methods presented in the thesis is based on ECG signals, we explain what constitutes such a signal and the methods that should be used before data compresison can be applied to them, such as filtering and quantization. Finally, we explore the application of biometric identification using the ECG signal into more depth, making some tests regarding the acquisition of signals and benchmark different proposals based on compresison methods, namely, non-fiducial ones. We also highlight the advantages of such an alternative approach to machine learning methods, namely, low computational costs and not requiring any kind of feature extraction, making this approach easily transferable into different applications and signals.A quantidade de dados recolhidos por sensores e dispositivos inteligentes que as pessoas utilizam no seu dia a dia tem aumentado a taxas mais elevadas do que nunca. Isso possibilita a utilização de sinais biomédicos em diversas aplicações práticas, com o auxílio de algoritmos de reconhecimento de padrões. Nesta tese, investigamos o uso de métodos baseados em compressão para realizar classificação de sinais unidimensionais. Para testar esses métodos, utilizamos, como aplicação de exemplo, o problema de identificação biométrica através de sinais eletrocardiográficos (ECG). Em primeiro lugar, introduzimos a noção de complexidade de Kolmogorov e a forma como a mesma se relaciona com os métodos de compressão. De seguida, explicamos como esses métodos são úteis para reconhecimento de padrões, explorando diferentes medidas baseadas em compressão, nomeadamente, a compressão relativa normalizada (NRC), uma medida baseada na similaridade relativa entre strings. Para isso, apresentamos os modelos de contexto finito e explicaremos a teoria por detrás de uma versão generalizada desses modelos, chamados de modelos de contexto finito de alfabeto estendido (xaFCM), uma nova contribuição. Uma vez que a aplicação de exemplo para os métodos apresentados na tese é baseada em sinais de ECG, explicamos também o que constitui tal sinal e os métodos que devem ser utilizados antes que a compressão de dados possa ser aplicada aos mesmos, tais como filtragem e quantização. Por fim, exploramos com maior profundidade a aplicação da identificação biométrica utilizando o sinal de ECG, realizando alguns testes relativos à aquisição de sinais e comparando diferentes propostas baseadas em métodos de compressão, nomeadamente os não fiduciais. Destacamos também as vantagens de tal abordagem, alternativa aos métodos de aprendizagem computacional, nomeadamente, baixo custo computacional bem como não exigir tipo de extração de atributos, tornando esta abordagem mais facilmente transponível para diferentes aplicações e sinais.Programa Doutoral em Informátic

Non-invasive multi-modal human identification system combining ECG, GSR, and airflow biosignals

A huge amount of data can be collected through a wide variety of sensor technologies. Data mining techniques are often useful for the analysis of gathered data. This paper studies the use of three wearable sensors that monitor the electrocardiogram, airflow, and galvanic skin response of a subject with the purpose of designing an efficient multi-modal human identification system. The proposed system, based on the rotation forest ensemble algorithm, offers a high accuracy (99.6 % true acceptance rate and just 0.1 % false positive rate). For its evaluation, the proposed system was testing against the characteristics commonly demanded in a biometric system, including universality, uniqueness, permanence, and acceptance. Finally, a proof-of-concept implementation of the system is demonstrated on a smartphone and its performance is evaluated in terms of processing speed and power consumption. The identification of a sample is extremely efficient, taking around 200 ms and consuming just a few millijoules. It is thus feasible to use the proposed system on a regular smartphone for user identification.This work was supported by MINECO grant TIN2013- 46469-R (SPINY: Security and Privacy in the Internet of You) and CAM grant S2013/ICE-3095 (CIBERDINE: Cybersecurity, Data, and Risks)