Security and privacy issues in implantable medical devices: A comprehensive survey

Bioengineering is a field in expansion. New technologies are appearing to provide a more efficient treatment of diseases or human deficiencies. Implantable Medical Devices (IMDs) constitute one example, these being devices with more computing, decision making and communication capabilities. Several research works in the computer security field have identified serious security and privacy risks in IMDs that could compromise the implant and even the health of the patient who carries it. This article surveys the main security goals for the next generation of IMDs and analyzes the most relevant protection mechanisms proposed so far. On the one hand, the security proposals must have into consideration the inherent constraints of these small and implanted devices: energy, storage and computing power. On the other hand, proposed solutions must achieve an adequate balance between the safety of the patient and the security level offered, with the battery lifetime being another critical parameter in the design phase. (C) 2015 Elsevier Inc. All rights reserved.This work was partially supported by the MINECO Grant TIN2013-46469-R (SPINY: Security and Privacy in the Internet of You)

Security and privacy issues in implantable medical devices: A comprehensive survey

Bioengineering is a field in expansion. New technologies are appearing to provide a more efficient treatment of diseases or human deficiencies. Implantable Medical Devices (IMDs) constitute one example, these being devices with more computing, decision making and communication capabilities. Several research works in the computer security field have identified serious security and privacy risks in IMDs that could compromise the implant and even the health of the patient who carries it. This article surveys the main security goals for the next generation of IMDs and analyzes the most relevant protection mechanisms proposed so far. On the one hand, the security proposals must have into consideration the inherent constraints of these small and implanted devices: energy, storage and computing power. On the other hand, proposed solutions must achieve an adequate balance between the safety of the patient and the security level offered, with the battery lifetime being another critical parameter in the design phase

Balancing Security and Utility in Medical Devices?

ABSTRACT Implantable Medical Devices (IMDs) are being embedded increasingly often in patients' bodies to monitor and help treat medical conditions. To facilitate monitoring and control, IMDs are often equipped with wireless interfaces. While convenient, wireless connectivity raises the risk of malicious access to an IMD that can potentially infringe patients' privacy and even endanger their lives. Thus, while ease of access to IMDs can be vital for timely medical intervention, too much ease is dangerous. Obvious approaches, such as passwords and certificates, are unworkable at large scale given the lack of central authorities and frequent emergencies in medical settings. Additionally, IMDs are heavily constrained in their power consumption and computational capabilities. Designing access-control mechanisms for IMDs that can meet the many constraints of real-world deployment is an important research challenge. In this paper, we review proposed approaches to the accesscontrol problem for IMDs, including the problem of secure pairing (and key distribution) between an IMD and another device, such as a programmer. (We also treat related technologies, such as bodyarea networks.) We describe some limitations of well-conceived proposals and reveal security weaknesses in two proposed cryptographic pairing schemes. Our intention is to stimulate yet more inventive and rigorous research in the intriguing and challenging areas of IMD security and medical-device security in general

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

Evidence-based Development of Trustworthy Mobile Medical Apps

abstract: Widespread adoption of smartphone based Mobile Medical Apps (MMAs) is opening new avenues for innovation, bringing MMAs to the forefront of low cost healthcare delivery. These apps often control human physiology and work on sensitive data. Thus it is necessary to have evidences of their trustworthiness i.e. maintaining privacy of health data, long term operation of wearable sensors and ensuring no harm to the user before actual marketing. Traditionally, clinical studies are used to validate the trustworthiness of medical systems. However, they can take long time and could potentially harm the user. Such evidences can be generated using simulations and mathematical analysis. These methods involve estimating the MMA interactions with human physiology. However, the nonlinear nature of human physiology makes the estimation challenging. This research analyzes and develops MMA software while considering its interactions with human physiology to assure trustworthiness. A novel app development methodology is used to objectively evaluate trustworthiness of a MMA by generating evidences using automatic techniques. It involves developing the Health-Dev β tool to generate a) evidences of trustworthiness of MMAs and b) requirements assured code generation for vulnerable components of the MMA without hindering the app development process. In this method, all requests from MMAs pass through a trustworthy entity, Trustworthy Data Manager which checks if the app request satisfies the MMA requirements. This method is intended to expedite the design to marketing process of MMAs. The objectives of this research is to develop models, tools and theory for evidence generation and can be divided into the following themes: • Sustainable design configuration estimation of MMAs: Developing an optimization framework which can generate sustainable and safe sensor configuration while considering interactions of the MMA with the environment. • Evidence generation using simulation and formal methods: Developing models and tools to verify safety properties of the MMA design to ensure no harm to the human physiology. • Automatic code generation for MMAs: Investigating methods for automatically • Performance analysis of trustworthy data manager: Evaluating response time generating trustworthy software for vulnerable components of a MMA and evidences.performance of trustworthy data manager under interactions from non-MMA smartphone apps.Dissertation/ThesisDoctoral Dissertation Computer Science 201

A Three – tier bio-implantable sensor monitoring and communications platform

One major hindrance to the advent of novel bio-implantable sensor technologies is the need for a reliable power source and data communications platform capable of continuously, remotely, and wirelessly monitoring deeply implantable biomedical devices. This research proposes the feasibility and potential of combining well established, ‘human-friendly' inductive and ultrasonic technologies to produce a proof-of-concept, generic, multi-tier power transfer and data communication platform suitable for low-power, periodically-activated implantable analogue bio-sensors. In the inductive sub-system presented, 5 W of power is transferred across a 10 mm gap between a single pair of 39 mm (primary) and 33 mm (secondary) circular printed spiral coils (PSCs). These are printed using an 8000 dpi resolution photoplotter and fabricated on PCB by wet-etching, to the maximum permissible density. Our ultrasonic sub-system, consisting of a single pair of Pz21 (transmitter) and Pz26 (receiver) piezoelectric PZT ceramic discs driven by low-frequency, radial/planar excitation (-31 mode), without acoustic matching layers, is also reported here for the first time. The discs are characterised by propagation tank test and directly driven by the inductively coupled power to deliver 29 μW to a receiver (implant) employing a low voltage start-up IC positioned 70 mm deep within a homogeneous liquid phantom. No batteries are used. The deep implant is thus intermittently powered every 800 ms to charge a capacitor which enables its microcontroller, operating with a 500 kHz clock, to transmit a single nibble (4 bits) of digitized sensed data over a period of ~18 ms from deep within the phantom, to the outside world. A power transfer efficiency of 83% using our prototype CMOS logic-gate IC driver is reported for the inductively coupled part of the system. Overall prototype system power consumption is 2.3 W with a total power transfer efficiency of 1% achieved across the tiers

CONFIDENCE-BASED DECISION-MAKING SUPPORT FOR MULTI-SENSOR SYSTEMS

We live in a world where computer systems are omnipresent and are connected to more and more sensors. Ranging from small individual electronic assistants like smartphones to complex autonomous robots, from personal wearable health devices to professional eHealth frameworks, all these systems use the sensors’ data in order to make appropriate decisions according to the context they measure. However, in addition to complete failures leading to the lack of data delivery, these sensors can also send bad data due to influences from the environment which can sometimes be hard to detect by the computer system when checking each sensor individually. The computer system should be able to use its set of sensors as a whole in order to mitigate the influence of malfunctioning sensors, to overcome the absence of data coming from broken sensors, and to handle possible conflicting information coming from several sensors. In this thesis, we propose a computational model based on a two layer software architecture to overcome this challenge. In a first layer, classification algorithms will check for malfunctioning sensors and attribute a confidence value to each sensor. In the second layer, a rule-based proactive engine will then build a representation of the context of the system and use it along some empirical knowledge about the weaknesses of the different sensors to further tweak this confidence value. Furthermore, the system will then check for conflicting data between sensors. This can be done by having several sensors that measure the same parameters or by having multiple sensors that can be used together to calculate an estimation of a parameter given by another sensor. A confidence value will be calculated for this estimation as well, based on the confidence values of the related sensors. The successive design refinement steps of our model are shown over the course of three experiments. The first two experiments, located in the eHealth domain, have been used to better identify the challenges of such multi-sensor systems, while the third experiment, which consists of a virtual robot simulation, acts as a proof of concept for the semi-generic model proposed in this thesis

From MANET to people-centric networking: Milestones and open research challenges

In this paper, we discuss the state of the art of (mobile) multi-hop ad hoc networking with the aim to present the current status of the research activities and identify the consolidated research areas, with limited research opportunities, and the hot and emerging research areas for which further research is required. We start by briefly discussing the MANET paradigm, and why the research on MANET protocols is now a cold research topic. Then we analyze the active research areas. Specifically, after discussing the wireless-network technologies, we analyze four successful ad hoc networking paradigms, mesh networks, opportunistic networks, vehicular networks, and sensor networks that emerged from the MANET world. We also present an emerging research direction in the multi-hop ad hoc networking field: people centric networking, triggered by the increasing penetration of the smartphones in everyday life, which is generating a people-centric revolution in computing and communications

Contributions to Context-Aware Smart Healthcare: A Security and Privacy Perspective

Les tecnologies de la informació i la comunicació han canviat les nostres vides de manera irreversible. La indústria sanitària, una de les indústries més grans i de major creixement, està dedicant molts esforços per adoptar les últimes tecnologies en la pràctica mèdica diària. Per tant, no és sorprenent que els paradigmes sanitaris estiguin en constant evolució cercant serveis més eficients, eficaços i sostenibles. En aquest context, el potencial de la computació ubiqua mitjançant telèfons intel·ligents, rellotges intel·ligents i altres dispositius IoT ha esdevingut fonamental per recopilar grans volums de dades, especialment relacionats amb l'estat de salut i la ubicació de les persones. Les millores en les capacitats de detecció juntament amb l'aparició de xarxes de telecomunicacions d'alta velocitat han facilitat la implementació d'entorns sensibles al context, com les cases i les ciutats intel·ligents, capaços d'adaptar-se a les necessitats dels ciutadans. La interacció entre la computació ubiqua i els entorns sensibles al context va obrir la porta al paradigma de la salut intel·ligent, centrat en la prestació de serveis de salut personalitzats i de valor afegit mitjançant l'explotació de grans quantitats de dades sanitàries, de mobilitat i contextuals. No obstant, la gestió de dades sanitàries, des de la seva recollida fins a la seva anàlisi, planteja una sèrie de problemes desafiants a causa del seu caràcter altament confidencial. Aquesta tesi té per objectiu abordar diversos reptes de seguretat i privadesa dins del paradigma de la salut intel·ligent. Els resultats d'aquesta tesi pretenen ajudar a la comunitat científica a millorar la seguretat dels entorns intel·ligents del futur, així com la privadesa dels ciutadans respecte a les seves dades personals i sanitàries.Las tecnologías de la información y la comunicación han cambiado nuestras vidas de forma irreversible. La industria sanitaria, una de las industrias más grandes y de mayor crecimiento, está dedicando muchos esfuerzos por adoptar las últimas tecnologías en la práctica médica diaria. Por tanto, no es sorprendente que los paradigmas sanitarios estén en constante evolución en busca de servicios más eficientes, eficaces y sostenibles. En este contexto, el potencial de la computación ubicua mediante teléfonos inteligentes, relojes inteligentes, dispositivos wearables y otros dispositivos IoT ha sido fundamental para recopilar grandes volúmenes de datos, especialmente relacionados con el estado de salud y la localización de las personas. Las mejoras en las capacidades de detección junto con la aparición de redes de telecomunicaciones de alta velocidad han facilitado la implementación de entornos sensibles al contexto, como las casas y las ciudades inteligentes, capaces de adaptarse a las necesidades de los ciudadanos. La interacción entre la computación ubicua y los entornos sensibles al contexto abrió la puerta al paradigma de la salud inteligente, centrado en la prestación de servicios de salud personalizados y de valor añadido mediante la explotación significativa de grandes cantidades de datos sanitarios, de movilidad y contextuales. No obstante, la gestión de datos sanitarios, desde su recogida hasta su análisis, plantea una serie de cuestiones desafiantes debido a su naturaleza altamente confidencial. Esta tesis tiene por objetivo abordar varios retos de seguridad y privacidad dentro del paradigma de la salud inteligente. Los resultados de esta tesis pretenden ayudar a la comunidad científica a mejorar la seguridad de los entornos inteligentes del futuro, así como la privacidad de los ciudadanos con respecto a sus datos personales y sanitarios.Information and communication technologies have irreversibly changed our lives. The healthcare industry, one of the world’s largest and fastest-growing industries, is dedicating many efforts in adopting the latest technologies into daily medical practice. It is not therefore surprising that healthcare paradigms are constantly evolving seeking for more efficient, effective and sustainable services. In this context, the potential of ubiquitous computing through smartphones, smartwatches, wearables and IoT devices has become fundamental to collect large volumes of data, including people's health status and people’s location. The enhanced sensing capabilities together with the emergence of high-speed telecommunication networks have facilitated the implementation of context-aware environments, such as smart homes and smart cities, able to adapt themselves to the citizens needs. The interplay between ubiquitous computing and context-aware environments opened the door to the so-called smart health paradigm, focused on the provision of added-value personalised health services by meaningfully exploiting vast amounts of health, mobility and contextual data. However, the management of health data, from their gathering to their analysis, arises a number of challenging issues due to their highly confidential nature. In particular, this dissertation addresses several security and privacy challenges within the smart health paradigm. The results of this dissertation are intended to help the research community to enhance the security of the intelligent environments of the future as well as the privacy of the citizens regarding their personal and health data