Medical Internet of Things: A Survey of the Current Threat and Vulnerability Landscape

The Internet of things (IoT) is a system that utilizes the Internet to facilitate communication between sensors and devices. Given the ubiquitous nature of IoT devices, it is seemingly inevitable that IoT would be used as a conduit to transform healthcare. One such medical IoT (mIoT) device that is revolutionizing healthcare is the medical implant device. These mIoT implant devices which control insulin pumps, cardioverter defibrillators and bone growth stimulators have redefined the way patient data is accessed, and healthcare is delivered. These implant devices are a double-edged sword. While they allow for the effective and efficient noninvasive treatment of patients, this external communication makes the medical implants vulnerable to cyberattacks synonymous with IoT devices. As a result, privacy and security vulnerabilities have surfaced as pronounced challenges for mIoT devices. This work summarizes and synthesizes the inherent vulnerabilities associated with mIoT devices and the implications regarding patient safety

IMDfence: Architecting a Secure Protocol for Implantable Medical Devices

Over the past decade, focus on the security and privacy aspects of implantable medical devices (IMDs) has intensified, driven by the multitude of cybersecurity vulnerabilities found in various existing devices. However, due to their strict computational, energy and physical constraints, conventional security protocols are not directly applicable to IMDs. Custom-tailored schemes have been proposed instead which, however, fail to cover the full spectrum of security features that modern IMDs and their ecosystems so critically require. In this paper we propose IMDfence, a security protocol for IMD ecosystems that provides a comprehensive yet practical security portfolio, which includes availability, non-repudiation, access control, entity authentication, remote monitoring and system scalability. The protocol also allows emergency access that results in the graceful degradation of offered services without compromising security and patient safety. The performance of the security protocol as well as its feasibility and impact on modern IMDs are extensively analyzed and evaluated. We find that IMDfence achieves the above security requirements at a mere less than 7% increase in total IMD energy consumption, and less than 14 ms and 9 kB increase in system delay and memory footprint, respectively

Designing Novel Hardware Security Primitives for Smart Computing Devices

Smart computing devices are miniaturized electronics devices that can sense their surroundings, communicate, and share information autonomously with other devices to work cohesively. Smart devices have played a major role in improving quality of the life and boosting the global economy. They are ubiquitously present, smart home, smart city, smart girds, industry, healthcare, controlling the hazardous environment, and military, etc. However, we have witnessed an exponential rise in potential threat vectors and physical attacks in recent years. The conventional software-based security approaches are not suitable in the smart computing device, therefore, hardware-enabled security solutions have emerged as an attractive choice. Developing hardware security primitives, such as True Random Number Generator (TRNG) and Physically Unclonable Function (PUF) from electrical properties of the sensor could be a novel research direction. Secondly, the Lightweight Cryptographic (LWC) ciphers used in smart computing devices are found vulnerable against Correlation Power Analysis (CPA) attack. The CPA performs statistical analysis of the power consumption of the cryptographic core and reveals the encryption key. The countermeasure against CPA results in an increase in energy consumption, therefore, they are not suitable for battery operated smart computing devices. The primary goal of this dissertation is to develop novel hardware security primitives from existing sensors and energy-efficient LWC circuit implementation with CPA resilience. To achieve these. we focus on developing TRNG and PUF from existing photoresistor and photovoltaic solar cell sensors in smart devices Further, we explored energy recovery computing (also known as adiabatic computing) circuit design technique that reduces the energy consumption compared to baseline CMOS logic design and same time increasing CPA resilience in low-frequency applications, e.g. wearable fitness gadgets, hearing aid and biomedical instruments. The first contribution of this dissertation is to develop a TRNG prototype from the uncertainty present in photoresistor sensors. The existing sensor-based TRNGs suffer a low random bit generation rate, therefore, are not suitable in real-time applications. The proposed prototype has an average random bit generation rate of 8 kbps, 32 times higher than the existing sensor-based TRNG. The proposed lightweight scrambling method results in random bit entropy close to ideal value 1. The proposed TRNG prototype passes all 15 statistical tests of the National Institute of Standards and Technology (NIST) Statistical Test Suite with quality performance. The second contribution of this dissertation is to develop an integrated TRNG-PUF designed using photovoltaic solar cell sensors. The TRNG and PUF are mutually independent in the way they are designed, therefore, integrating them as one architecture can be beneficial in resource-constrained computing devices. We propose a novel histogram-based technique to segregate photovoltaic solar cell sensor response suitable for TRNG and PUF respectively. The proposed prototype archives approximately 34\% improvement in TRNG output. The proposed prototype achieves an average of 92.13\% reliability and 50.91\% uniformity performance in PUF response. The proposed sensor-based hardware security primitives do not require additional interfacing hardware. Therefore, they can be ported as a software update on existing photoresistor and photovoltaic sensor-based devices. Furthermore, the sensor-based design approach can identify physically tempered and faulty sensor nodes during authentication as their response bit differs. The third contribution is towards the development of a novel 2-phase sinusoidal clocking implementation, 2-SPGAL for existing Symmetric Pass Gate Adiabatic Logic (SPGAL). The proposed 2-SPGAL logic-based LWC cipher PRESENT shows an average of 49.34\% energy saving compared to baseline CMOS logic implementation. Furthermore, the 2-SPGAL prototype has an average of 22.76\% better energy saving compared to 2-EE-SPFAL (2-phase Energy-Efficient-Secure Positive Feedback Adiabatic Logic). The proposed 2-SPGAL was tested for energy-efficiency performance for the frequency range of 50 kHz to 250 kHz, used in healthcare gadgets and biomedical instruments. The proposed 2-SPGAL based design saves 16.78\% transistor count compared to 2-EE-SPFAL counterpart. The final contribution is to explore Clocked CMOS Adiabatic Logic (CCAL) to design a cryptographic circuit. Previously proposed 2-SPGAL and 2-EE-SPFAL uses two complementary pairs of the transistor evaluation network, thus resulting in a higher transistor count compared to the CMOS counterpart. The CCAL structure is very similar to CMOS and unlike 2-SPGAL and 2-EE-SPFAL, it does not require discharge circuitry to improve security performance. The case-study implementation LWC cipher PRESENT S-Box using CCAL results into 45.74\% and 34.88\% transistor count saving compared to 2-EE-SPFAL and 2-SPGAL counterpart. Furthermore, the case-study implementation using CCAL shows more than 95\% energy saving compared to CMOS logic at frequency range 50 kHz to 125 kHz, and approximately 60\% energy saving at frequency 250 kHz. The case study also shows 32.67\% and 11.21\% more energy saving compared to 2-EE-SPFAL and 2-SPGAL respectively at frequency 250 kHz. We also show that 200 fF of tank capacitor in the clock generator circuit results in optimum energy and security performance in CCAL

Secure lightweight protocols for medical device monitoring

In the present days, the health care costs are sky-rocketing and most developed nations, including EU and US, are struggling to keep the costs under control. One of the areas is related to monitoring and control of medical appliances embedded to human bodies, such as insulin pumps as heart pacers. Fortunately, recent technology advances make it possible to monitor the medical appliances remotely, greatly decreasing the need for personal doctor visits. Naturally, remote wireless monitoring of such crucial appliances poses several formidable technological challenges including security of data communication, device authentication, attack resistance, and seamless connectivity. A remote monitoring protocol must be executed in a resource-constrained environment with energy efficiency. The recently proposed Diet Exchange for Host Identity Protocol (HIP) could solve most of security issues of remote appliance monitoring. However, it has to be developed to run in an embedded device environment; its security properties must be triple-checked against the stringent requirements; potential privacy issues must be addressed; protocol messages and cryptographic mechanisms must be adopted to wireless sensor standards. Although bearing high risks of provable security and patient faith, remote monitoring of health appliances could create breakthroughs in healthcare cost reduction and bring great benefits of individuals and the society

Transiently Powered Computers

Demand for compact, easily deployable, energy-efficient computers has driven the development of general-purpose transiently powered computers (TPCs) that lack both batteries and wired power, operating exclusively on energy harvested from their surroundings. TPCs\u27 dependence solely on transient, harvested power offers several important design-time benefits. For example, omitting batteries saves board space and weight while obviating the need to make devices physically accessible for maintenance. However, transient power may provide an unpredictable supply of energy that makes operation difficult. A predictable energy supply is a key abstraction underlying most electronic designs. TPCs discard this abstraction in favor of opportunistic computation that takes advantage of available resources. A crucial question is how should a software-controlled computing device operate if it depends completely on external entities for power and other resources? The question poses challenges for computation, communication, storage, and other aspects of TPC design. The main idea of this work is that software techniques can make energy harvesting a practicable form of power supply for electronic devices. Its overarching goal is to facilitate the design and operation of usable TPCs. This thesis poses a set of challenges that are fundamental to TPCs, then pairs these challenges with approaches that use software techniques to address them. To address the challenge of computing steadily on harvested power, it describes Mementos, an energy-aware state-checkpointing system for TPCs. To address the dependence of opportunistic RF-harvesting TPCs on potentially untrustworthy RFID readers, it describes CCCP, a protocol and system for safely outsourcing data storage to RFID readers that may attempt to tamper with data. Additionally, it describes a simulator that facilitates experimentation with the TPC model, and a prototype computational RFID that implements the TPC model. To show that TPCs can improve existing electronic devices, this thesis describes applications of TPCs to implantable medical devices (IMDs), a challenging design space in which some battery-constrained devices completely lack protection against radio-based attacks. TPCs can provide security and privacy benefits to IMDs by, for instance, cryptographically authenticating other devices that want to communicate with the IMD before allowing the IMD to use any of its battery power. This thesis describes a simplified IMD that lacks its own radio, saving precious battery energy and therefore size. The simplified IMD instead depends on an RFID-scale TPC for all of its communication functions. TPCs are a natural area of exploration for future electronic design, given the parallel trends of energy harvesting and miniaturization. This work aims to establish and evaluate basic principles by which TPCs can operate

Survey and Systematization of Secure Device Pairing

Secure Device Pairing (SDP) schemes have been developed to facilitate secure communications among smart devices, both personal mobile devices and Internet of Things (IoT) devices. Comparison and assessment of SDP schemes is troublesome, because each scheme makes different assumptions about out-of-band channels and adversary models, and are driven by their particular use-cases. A conceptual model that facilitates meaningful comparison among SDP schemes is missing. We provide such a model. In this article, we survey and analyze a wide range of SDP schemes that are described in the literature, including a number that have been adopted as standards. A system model and consistent terminology for SDP schemes are built on the foundation of this survey, which are then used to classify existing SDP schemes into a taxonomy that, for the first time, enables their meaningful comparison and analysis.The existing SDP schemes are analyzed using this model, revealing common systemic security weaknesses among the surveyed SDP schemes that should become priority areas for future SDP research, such as improving the integration of privacy requirements into the design of SDP schemes. Our results allow SDP scheme designers to create schemes that are more easily comparable with one another, and to assist the prevention of persisting the weaknesses common to the current generation of SDP schemes.Comment: 34 pages, 5 figures, 3 tables, accepted at IEEE Communications Surveys & Tutorials 2017 (Volume: PP, Issue: 99