Security issues in healthcare applications using wireless medical sensor networks: a survey

Enhancing security in Wireless Body Area Networks (WBANs) with ECC-based Diffie-Hellman Key Exchange algorithm (ECDH)

BACKGROUND

Wireless Body Area Networks (WBANs) are integral to modern healthcare systems, providing continuous health monitoring and real-time data transmission. The sensitivity of medical data being transmitted makes security a significant concern in WBANs.

OBJECTIVE

This study explores the application of the Elliptic Curve Cryptography (ECC)-based Diffie-Hellman Key Exchange (ECDH) algorithm to enhance security within WBANs.

METHOD

The study investigates the suitability of ECC for this context and evaluates the performance and security implications of implementing ECDH in WBANs.

RESULTS

The findings reveal that ECDH provides a robust and computationally efficient solution for secure key exchange in WBANs, addressing inherent vulnerabilities.

CONCLUSION

The adoption of ECC-based ECDH is poised to bolster data confidentiality and integrity in WBANs, promoting trust and widespread use of these networks in healthcare applications. This research contributes to the growing body of knowledge regarding security measures in WBANs and opens new avenues for the secure transmission of sensitive medical information.

E-Health Interventions for Older Adults With Frailty: A Systematic Review

OBJECTIVE

: To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.

METHODS

: A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected.

RESULTS

: Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07-0.94; p=0.80, I2=0%).

CONCLUSION

: This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

Cybersecurity in Internet of Medical Vehicles: State-of-the-Art Analysis, Research Challenges and Future Perspectives

The "Internet-of-Medical-Vehicles (IOMV)" is one of the special applications of the Internet of Things resulting from combining connected healthcare and connected vehicles. As the IOMV communicates with a variety of networks along its travel path, it incurs various security risks due to sophisticated cyber-attacks. This can endanger the onboard patient's life. So, it is critical to understand subjects related to "cybersecurity" in the IOMV to develop robust cybersecurity measures. In this paper, the goal is to evaluate recent trends and state-of-the-art publications, gaps, and future outlooks related to this research area. With this aim, a variety of publications between 2016 and 2023 from "Web-of-Science" and "Scopus" databases were analysed. Our analysis revealed that the IOMV is a niche and unexplored research area with few defined standards and frameworks, and there is a great need to implement robust cybersecurity measures. This paper will help researchers to gain a comprehensive idea of this niche research topic, as it presents an analysis of top journals and highly cited papers, their challenges and limitations, the system model and architecture of the IOMV, related applicable standards, potential cyber-attacks, factors causing cybersecurity risks, various artificial intelligence techniques for developing potential countermeasures, the assessment and parameterisation of cybersecurity risks, constraints and challenges, and future outlooks for implementing cybersecurity measures in the IOMV.

Octopus: A Novel Approach for Health Data Masking and Retrieving Using Physical Unclonable Functions and Machine Learning

Health equipment are used to keep track of significant health indicators, automate health interventions, and analyze health indicators. People have begun using mobile applications to track health characteristics and medical demands because devices are now linked to high-speed internet and mobile phones. Such a combination of smart devices, the internet, and mobile applications expands the usage of remote health monitoring through the Internet of Medical Things (IoMT). The accessibility and unpredictable aspects of IoMT create massive security and confidentiality threats in IoMT systems. In this paper, Octopus and Physically Unclonable Functions (PUFs) are used to provide privacy to the healthcare device by masking the data, and machine learning (ML) techniques are used to retrieve the health data back and reduce security breaches on networks. This technique has exhibited 99.45% accuracy, which proves that this technique could be used to secure health data with masking.

Comparison of Collaborative and Cooperative Schemes in Sensor Networks for Non-Invasive Monitoring of People at Home

This paper looks at wireless sensor networks (WSNs) in healthcare, where they can monitor patients remotely. WSNs are considered one of the most promising technologies due to their flexibility and autonomy in communication. However, routing protocols in WSNs must be energy-efficient, with a minimal quality of service, so as not to compromise patient care. The main objective of this work is to compare two work schemes in the routing protocol algorithm in WSNs (cooperative and collaborative) in a home environment for monitoring the conditions of the elderly. The study aims to optimize the performance of the algorithm and the ease of use for people while analyzing the impact of the sensor network on the analysis of vital signs daily using medical equipment. We found relationships between vital sign metrics that have a more significant impact in the presence of a monitoring system. Finally, we conduct a performance analysis of both schemes proposed for the home tracking application and study their usability from the user's point of view.

OTP-Q encryption and Diffie-Hellman mutual authentication for e-healthcare data based on lightweight S-WBSN framework

BACKGROUND

Protection of wireless technology-enabled e-healthcare data transfer over constrained devices of body sensor networks using lightweight security mechanisms is the demand of health sector nowadays.

OBJECTIVE

A new secure wireless body sensor network architecture (S-WBSN) with reduced CPU cycles and computational cost is proposed. S-WBSN uses OTP-Q (One-Time Pad-Quasi) and Diffie-Hellman key exchange algorithms for encryption and mutual authentication, respectively.

METHODS

To ensure mutual authentication among and components, the Diffie-Hellman key exchange algorithm is used. Using the S-WBSN architecture, security requirements such as mutual authentication, and privacy preservation thwarting security attacks are perfectly met comparing other security-based research works on healthcare data monitoring.

RESULTS

The one-time pad-based quasi-group algorithm is a stream block cipher that operates on the data observed from the sensors of the WBSN. Before transmitting encrypted data, authentication is to be established.

CONCLUSION

The proposed system methodology proves to be efficient and consumes fewer CPU cycles. The encryption and decryption processing times are comparatively less than the state-of-the-art approaches.

A Survey of Authentication in Internet of Things-Enabled Healthcare Systems

The Internet of medical things (IoMT) provides an ecosystem in which to connect humans, devices, sensors, and systems and improve healthcare services through modern technologies. The IoMT has been around for quite some time, and many architectures/systems have been proposed to exploit its true potential. Healthcare through the Internet of things (IoT) is envisioned to be efficient, accessible, and secure in all possible ways. Even though the personalized health service through IoT is not limited to time or location, many associated challenges have emerged at an exponential pace. With the rapid shift toward IoT-enabled healthcare systems, there is an extensive need to examine possible threats and propose countermeasures. Authentication is one of the key processes in a system's security, where an individual, device, or another system is validated for its identity. This survey explores authentication techniques proposed for IoT-enabled healthcare systems. The exploration of the literature is categorized with respect to the technology deployment region, as in cloud, fog, and edge. A taxonomy of attacks, comprehensive analysis, and comparison of existing authentication techniques opens up possible future directions and paves the road ahead.

Epidemic Healthcare Kiosk

One of the most difficult tasks for the physicians is to analyze, manage, and plan suitable diagnoses and treatments for society, especially in an epidemic situation like Corona virus disease (COVID-19). Hence, the mortality rate shoots up. The ultimate reason for such pathetic situation is due to large mass of people being infected, lack of physicians and testing staff, and the threat of physicians themselves being infected while testing patients. This article proposes a solution to tackle this major issue worldwide. This article portrays the methodology of an IoT-interfaced epidemic healthcare kiosk (EHK)-intelligent monitoring system to plan and manage epidemics. The EHK is a non-invasive data acquisition system that consists of several sensors that can record the physiological measurements of the EHK user. The measured parameters are computed using quantum machine learning techniques. The proposed ideology can reduce the mortality rate, control the epidemic, and moreover, provide safety to citizens and physicians.

Axillary temperature measurements based on smart wearable thermometers in South Korean children: comparison with tympanic temperature measurements

Purpose: This study explored the validity of a new type of thermometer and parent satisfaction with the new device. This 24-hour continuous monitoring smart wearable wireless thermometer (TempTraq®) uses a very small semiconductor sensor with a thin patch-like shape.Methods: We obtained 397 sets of TempTraq® axillary temperatures and tympanic temperatures from 44 pediatric patients. Agreement between the axillary and tympanic measurements, as well as the validity of the TempTraq® axillary temperatures, were evaluated. Satisfaction surveys were completed by 41 caregivers after the measurements.Results: The TempTraq® axillary temperatures demonstrated a strong positive correlation with the tympanic temperatures. The Bland-Altman plot and analysis of TempTraq® axillary temperatures and tympanic temperatures showed that the mean difference was +0.45 ℃, the 95% limits of agreement were -0.57 to +1.46 ℃. Based on a tympanic temperature of 38 ℃, the results of validity of fever detection were sensitivity 0.85 and specificity 0.86. Satisfaction scores for TempTraq® temperature measurement were all > 4 points (satisfactory).Conclusion: TempTraq® smart axillary temperature measurement is an appropriate method for measuring children's temperatures since it was highly correlated to tympanic temperatures, had a reliable level of sensitivity and specificity, and could be used safely and conveniently.

Cybersecurity Enterprises Policies: A Comparative Study

Cybersecurity is a critical issue that must be prioritized not just by enterprises of all kinds, but also by national security. To safeguard an organization’s cyberenvironments, information, and communication technologies, many enterprises are investing substantially in cybersecurity these days. One part of the cyberdefense mechanism is building an enterprises’ security policies library, for consistent implementation of security controls. Significant and common cybersecurity policies of various enterprises are compared and explored in this study to provide robust and comprehensive cybersecurity knowledge that can be used in various enterprises. Several significant common security policies were identified and discussed in this comprehensive study. This study identified 10 common cybersecurity policy aspects in five enterprises: healthcare, finance, education, aviation, and e-commerce. We aimed to build a strong infrastructure in each business, and investigate the security laws and policies that apply to all businesses in each sector. Furthermore, the findings of this study reveal that the importance of cybersecurity requirements differ across multiple organizations. The choice and applicability of cybersecurity policies are determined by the type of information under control and the security requirements of organizations in relation to these policies.

FPGA Implementation of Mutual Authentication Protocol for Medication Security System

Medication safety administration is a complicated process involving the information of patients, drugs, and data storage. The sensitive data transmitted through wireless sensor networks (WSNs) from Internet of things (IoT) over an insecure channel is vulnerable to several threats and needs proper attention to be secured from adversaries. Taking medication safety into consideration, this paper presents a secure authentication protocol for wireless medical sensor networks. The XOR scheme-based algorithm is applied to achieve the purposes of data confidentiality. The proposed architecture is realized as hardware in a field-programmable gate array (FPGA) device which acts as a secure edge computing device. The performance of the proposed protocol is evaluated and simulated via Verilog hardware description language. The functionality of the proposed protocol is verified using the Altera Quartus II software tool and implemented in the Altera Cyclone II DE2-70 FPGA development module. Furthermore, the output signals from the FPGA are measured in the 16702A logic analyzer system to demonstrate real-time functional verification.

Challenges and Developments in Secure Routing Protocols for Healthcare in WBAN: A Comparative Analysis

The rise in life expectancy of humans, COVID-19 pandemic and growing cost of medical services has brought up huge challenges for the government and healthcare industry. Due to unhealthy lifestyle, there is an increased need for continual health monitoring and diagnosis of diseases. Wireless Body Area Network (WBAN) is attracted attention of researchers as various biosensors can be embedded in or worn on the body of human beings for the measurement of health parameters. The patient's health data is then sent wirelessly to the physician for health analysis. The biosensors used to measure physiological parameters have limited power due to its small size and hence smaller form factor. For the longevity of the network, it is imperative to transmit the data in an energy-efficient manner. Moreover, the health information of the patient is stringently private. Hence, the privacy and security of transmitted information needs to be ensured. It necessitates the development of effective, lightweight and secure routing protocols that provides security with minimal use of resources. This paper has identified the numerous security requirements in WBANs and has provided the extensive review on existing secure routing protocols reported in the literature. A comparative analysis of the various existing state-of-the art secure routing protocols and critical analysis based on security techniques along with different performance parameters has been presented.

Regulatory, Legal, and Market Aspects of Smart Wearables for Cardiac Monitoring

In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access are often evolving slowly, sometimes creating market barriers. This article gives a brief overview of the existing clinical studies regarding the use of smart wearables in cardiac monitoring and provides insight into the main regulatory and legal aspects that need to be considered when such products are intended to be used in a health care setting. Based on this brief overview, the article elaborates on the specific requirements in the main areas of authorization/certification and reimbursement/compensation, as well as data protection and data security. Three case studies are presented as examples of specific market access procedures: the USA, Germany, and Belgium. This article concludes that, despite the differences in specific requirements, market access pathways in most countries are characterized by a number of similarities, which should be considered early on in product development. The article also elaborates on how regulatory and legal requirements are currently being adapted for digitally driven wearables and proposes an ongoing evolution of these requirements to facilitate market access for beneficial medical technology in the future.

Cross-SN: A Lightweight Authentication Scheme for a Multi-Server Platform Using IoT-Based Wireless Medical Sensor Network

Several wireless devices and applications can be connected through wireless communication technologies to exchange data in future intelligent health systems (e.g., the Internet of Medical Things (IoMT)). Smart healthcare requires ample bandwidth, reliable and effective communications networks, energy-efficient operations, and quality of service support (QoS). Healthcare service providers host multi-servers to ensure seamless services are provided to the end-users. By supporting a multi-server environment, healthcare medical sensors produce many data transmitted via servers, which is impossible in a single-server architecture. To ensure data security, secure online communication must be considered since the transmitted data are sensitive. Hence, the adversary may try to interrupt the transmission and drop or modify the message. Many researchers have proposed an authentication scheme to secure the data, but the schemes are vulnerable to specific attacks (modification attacks, replay attacks, server spoofing attacks, Man-in-the middle (MiTM) attacks, etc.). However, the absence of an authentication scheme that supports a multi-server security in such a comprehensive development in a distributed server is still an issue. In this paper, a secure authentication scheme using wireless medical sensor networks for a multi-server environment is proposed (Cross-SN). The scheme is implemented with a smart card, password, and user identity. Elliptic curve cryptography is utilized in the scheme, and Burrows–Abadi–Needham (BAN) logic is utilized to secure mutual authentication and to analyse the proposed scheme’s security. It offers adequate protection against replies, impersonation, and privileged insider attacks and secure communication in multi-server parties that communicate with each other.

Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study

BACKGROUND

Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization.

OBJECTIVE

This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors.

METHODS

Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework.

RESULTS

Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the "gulf" that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error "Copied and pasted charting in the wrong window: Before, you could not easily get into someone else's chart accidentally...because you would have to pull the chart and open it," medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error.

CONCLUSIONS

Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety.

Wireless technologies, medical applications and future challenges in WBAN: a survey

Interest and need for Wireless Body Area Networks (WBANs) have significantly increased recently. WBAN consists of miniaturized sensors designed to collect and transmit data through wireless network, enabling medical specialists to monitor patients during their normal daily life and providing real time opinions for medical diagnosis. Many wireless technologies have proved themselves in WBAN applications, while others are still under investigations. The choice of the technology to adopt may depend on the disease to monitor and the performance requirements, i.e. reliability, latency and data rate. In addition, the suitable sensor is essential when seeking to extract the data related to a medical measure. This paper aims at surveying the wireless technologies used in WBAN systems. In addition to a detailed survey on the existing technologies, the use of the emerging Low Power Wide Area Network (LPWAN) technologies, and the future 5G, B5G and 6G is investigated, where the suitability of these technologies to WBAN applications is studied from several perspectives. Furthermore, medical applications of WBAN are discussed by presenting their methodologies, the adopted wireless technologies and the used sensors. Given that each medical application requires the appropriate sensor to extract the data, we highlight a wide range of the sensors used in the market for medical systems. Recent and future challenges in WBAN systems are given related to the power consumption, the emergence of the Internet of Things (IoT) technologies in WBAN and others.

Artificial intelligence and multi agent based distributed ledger system for better privacy and security of electronic healthcare records

BACKGROUND

Application of Artificial Intelligence (AI) and the use of agent-based systems in the healthcare system have attracted various researchers to improve the efficiency and utility in the Electronic Health Records (EHR). Nowadays, one of the most important and creative developments is the integration of AI and Blockchain that is, Distributed Ledger Technology (DLT) to enable better and decentralized governance. Privacy and security is a critical piece in EHR implementation and/or adoption. Health records are updated every time a patient visits a doctor as they contain important information about the health and wellbeing of the patient and describes the history of care received during the past and to date. Therefore, such records are critical to research, hospitals, emergency rooms, healthcare laboratories, and even health insurance providers.

METHODS

In this article, a platform employing the AI and the use of multi-agent based systems along with the DLT technology for privacy preservation is proposed. The emphasis of security and privacy is highlighted during the process of collecting, managing and distributing EHR data.

RESULTS

This article aims to ensure privacy, integrity and security metrics of the electronic health records are met when such copies are not only immutable but also distributed. The findings of this work will help guide the development of further techniques using the combination of AI and multi-agent based systems backed by DLT technology for secure and effective handling EHR data. This proposed architecture uses various AI-based intelligent based agents and blockchain for providing privacy and security in EHR. Future enhancement in this work can be the addition of the biometric based systems for improved security.

A Survey on Trust Management for WBAN: Investigations and Future Directions

The rapid uptake of the Wireless Body Area Networks (WBAN) and their services poses unprecedented security requirements. WBAN are evolving to support these requirements. Fulfilling these tasks is challenging as their mobile context is increasingly complex, heterogeneous, and evolving. One potential solution to meet the WBAN security requirements is trust management that helps to reach a more secure and adaptable WBAN environment. Accordingly, this article aims to serve as a brief survey of trust management approaches within intra-WBAN and inter-WBAN. For that, we first summarize trust management concepts, discuss WBAN challenges and classify the attacks on WBAN trust management models. Subsequently, we detail and compare the existing trust based approaches in a WBAN context. We pinpoint their limitations and provide a new classification of these different approaches. We also propose a set of best practices that may help the reader to build a robust and an efficient trust management framework. We complete this survey by highlighting the open future directions and perspectives for research.

REISCH: Incorporating Lightweight and Reliable Algorithms into Healthcare Applications of WSNs

Healthcare institutions require advanced technology to collect patients’ data accurately and continuously. The tradition technologies still suffer from two problems: performance and security efficiency. The existing research has serious drawbacks when using public-key mechanisms such as digital signature algorithms. In this paper, we propose Reliable and Efficient Integrity Scheme for Data Collection in HWSN (REISCH) to alleviate these problems by using secure and lightweight signature algorithms. The results of the performance analysis indicate that our scheme provides high efficiency in data integration between sensors and server (saves more than 24% of alive sensors compared to traditional algorithms). Additionally, we use Automated Validation of Internet Security Protocols and Applications (AVISPA) to validate the security procedures in our scheme. Security analysis results confirm that REISCH is safe against some well-known attacks.

A Lightweight Key Agreement Protocol Based on Chinese Remainder Theorem and ECDH for Smart Homes

Security and efficiency are the two main challenges for designing a smart home system. In this paper, by incorporating Chinese remainder theorem (CRT) into the elliptic curve Diffie-Hellman (ECDH), a lightweight key agreement protocol for smart home systems is constructed. Firstly, one-way hash authentication is used to identify the sensor nodes instead of mutual authentication to reduce the authentication cost. Secondly, the CRT is introduced to enhance the security of the original ECDH key agreement. Security analysis showed that the proposed protocol can validate the data integrity and resist the replay attack, the man-in-middle attack, and other attacks. Performance analysis and experiments showed that the protocol achieves high security with low communication and computation costs, and can be implemented in smart home systems.

Biosensors to monitor MS activity

Advances in wearable and wireless biosensing technology pave the way for a brave new world of novel multiple sclerosis (MS) outcome measures. Our current tools for examining patients date back to the 19th century and while invaluable to the neurologist invite accompaniment from these new technologies and artificial intelligence (AI) analytical methods. While the most common biosensor tool used in MS publications to date is the accelerometer, the landscape is changing quickly with multi-sensor applications, electrodermal sensors, and wireless radiofrequency waves. Some caution is warranted to ensure novel outcomes have clear clinical relevance and stand-up to the rigors of reliability, reproducibility, and precision, but the ultimate implementation of biosensing in the MS clinical setting is inevitable.

A Survey of Healthcare Internet-of-Things (HIoT): A Clinical Perspective

In combination with current sociological trends, the maturing development of IoT devices is projected to revolutionize healthcare. A network of body-worn sensors, each with a unique ID, can collect health data that is orders-of-magnitude richer than what is available today from sporadic observations in clinical/hospital environments. When databased, analyzed, and compared against information from other individuals using data analytics, HIoT data enables the personalization and modernization of care with radical improvements in outcomes and reductions in cost. In this paper, we survey existing and emerging technologies that can enable this vision for the future of healthcare, particularly in the clinical practice of healthcare. Three main technology areas underlie the development of this field: (a) sensing, where there is an increased drive for miniaturization and power efficiency; (b) communications, where the enabling factors are ubiquitous connectivity, standardized protocols, and the wide availability of cloud infrastructure, and (c) data analytics and inference, where the availability of large amounts of data and computational resources is revolutionizing algorithms for individualizing inference and actions in health management. Throughout the paper, we use a case study to concretely illustrate the impact of these trends. We conclude our paper with a discussion of the emerging directions, open issues, and challenges.

A Generic Model of the Pseudo-Random Generator Based on Permutations Suitable for Security Solutions in Computationally-Constrained Environments

Symmetric cryptography methods have an important role in security solutions design in data protection. In that context, symmetric cryptography algorithms and pseudo-random generators connected with them have strong influence on designed security solutions. In the computationally constrained environment, security efficiency is also important. In this paper we proposed the design of a new efficient pseudo-random generator parameterized by two pseudo-random sequences. By the probabilistic, information-theoretic and number theory methods we analyze characteristics of the generator. Analysis produced several results. We derived sufficient conditions, regarding parameterizing sequences, so that the output sequence has uniform distribution. Sufficient conditions under which there is no correlation between parameterizing sequences and output sequence are also derived. Moreover, it is shown that mutual information between the output sequence and parameterizing sequences tends to zero when the generated output sequence length tends to infinity. Regarding periodicity, it is shown that, with appropriately selected parameterizing sequences, the period of the generated sequence is significantly longer than the periods of the parameterizing sequences. All this characteristics are desirable regarding security applications. The efficiency of the proposed construction can be achieved by selection parameterizing sequences from the set of efficient pseudo-random number generators, for example, multiple linear feedback shift registers.

Body-to-Body Cooperation in Internet of Medical Things: Toward Energy Efficiency Improvement

Internet of Medical Things (IoMT) technologies provide suitability among physicians and patients because they are useful in numerous medical fields. Wireless body sensor networks (WBSNs) are one of the most crucial technologies from within the IoMT evolution of the healthcare system, whereby each patient is monitored by low-powered and lightweight sensors. When the WBSNs are integrated into IoMT networks, they are quite likely to overlap each other; thus, cooperation between WBSN sensors is possible. In this paper, we consider communication between WBSNs and beyond their communication range. Therefore, we propose inter-WBAN cooperation for the IoMT system, which is also known as inter-WBAN cooperation in an IoMT environment (IWC-IoMT). In this paper, first, a proposed architecture for the IoT health-based system is investigated. Then, a mathematical model of the outage probability for the IWC-IoMT is derived. Finally, the energy efficiency of the IWC-IoT is analysed and inspected. The simulation and numerical results show that the IWC-IoMT (cooperative IoMT) system provides superior performance compared to the non-cooperative system.

Ambulatory cardiac bio-signals: From mirage to clinical reality through a decade of progress

BACKGROUND

Health monitoring is shifting towards continuous, ambulatory and clinically comparable wearable devices. Telemedicine and remote diagnosis could harness the capability of mobile cardiac health information, as the technology on bio-physical signal monitoring has improved significantly.

OBJECTIVES

The purpose of this review article is (1) to systematically assess the viability of ambulatory electrocardiography (ECG), (2) to provide a systems level understanding of a broad spectrum of wearable heart signal monitoring approaches and (3) to identify areas of improvement in the existing technology needed to attain clinical grade diagnosis.

RESULTS

Based on the included literature, we have identified (1) that the developments in ECG monitoring through wearable devices are reaching feasibility, and are capable of delivering diagnostic and prognostic information, (2) that reliable sensing is the major bottleneck in the entire process of ambulatory monitoring, (3) that there is a strong need for artificial intelligence and machine learning techniques to parse and infer the biosignals and (4) that aspects of wearer comfort has largely been ignored in the prevailing developments, which can become a key factor for consumer acceptance.

CONCLUSIONS

Cardiac health information is crucial for diagnosis and prevention of several disease onsets. Mobile and continuous monitoring can aid avoiding risks involved with acute symptoms. The health information obtained through continuous monitoring can serve as the BigData of heart signals, and can facilitate new treatment methods and devise effective health policies.

Privacy Enhanced Healthcare Information Sharing System for Home-Based Care Environments

Objectives

Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems.

Methods

We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government.

Results

Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions.

Conclusions

The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.

Energy/Area-Efficient Scalar Multiplication with Binary Edwards Curves for the IoT

Making Elliptic Curve Cryptography (ECC) available for the Internet of Things (IoT) and related technologies is a recent topic of interest. Modern IoT applications transfer sensitive information which needs to be protected. This is a difficult task due to the processing power and memory availability constraints of the physical devices. ECC mainly relies on scalar multiplication (kP)—which is an operation-intensive procedure. The broad majority of kP proposals in the literature focus on performance improvements and often overlook the energy footprint of the solution. Some IoT technologies—Wireless Sensor Networks (WSN) in particular—are critically sensitive in that regard. In this paper we explore energy-oriented improvements applied to a low-area scalar multiplication architecture for Binary Edwards Curves (BEC)—selected given their efficiency. The design and implementation costs for each of these energy-oriented techniques—in hardware—are reported. We propose an evaluation method for measuring the effectiveness of these optimizations. Under this novel approach, the energy-reducing techniques explored in this work contribute to achieving the scalar multiplication architecture with the most efficient area/energy trade-offs in the literature, to the best of our knowledge.

Considerations for the Development of Mobile Phone Apps to Support Diabetes Self-Management: Systematic Review

Background

There is increased research interest in the use of mobile phone apps to support diabetes management. However, there are divergent views on what constitute the minimum standards for inclusion in the development of mobile phone apps. Mobile phone apps require an evidence-based approach to development which will consequently impact on their effectiveness. Therefore, comprehensive information on developmental considerations could help designers and researchers to develop innovative and effective patient-centered self-management mobile phone apps for diabetes patients.

Objective

This systematic review examined the developmental considerations adopted in trials that engaged mobile phone applications for diabetes self-management.

Methods

A comprehensive search strategy was implemented across 5 electronic databases; Medline, Scopus, Social Science Citation Index, the Cochrane Central Register of Controlled Trials and Cumulative Index of Nursing and Allied Health Literature (CINALHL) and supplemented by reference list from identified studies. Study quality was evaluated using the Joanna Briggs Critical appraisal checklist for trials. Information on developmental factors (health behavioral theory, functionality, pilot testing, user and clinical expert involvements, data privacy and app security) were assessed across experimental studies using a template developed for the review.

Results

A total of 11 studies (10 randomized controlled trials and 1 quasi-experimental trial) that fitted the inclusion criteria were identified. All the included studies had the functionality of self-monitoring of blood glucose. However, only some of them included functions for data analytics (7/11, 63.6%), education (6/11, 54.5%) and reminder (6/11, 54.5%). There were 5/11(45.5%) studies with significantly improved glycosylated hemoglobin in the intervention groups where educational functionality was present in the apps used in the 5 trials. Only 1 (1/11, 9.1%) study considered health behavioral theory and user involvement, while 2 (2/11, 18.1%) other studies reported the involvement of clinical experts in the development of their apps. There were 4 (4/11, 36.4%) studies which referred to data security and privacy considerations during their app development while 7 (7/12, 63.6%) studies provided information on pilot testing of apps before use in the full trial. Overall, none of the studies provided information on all developmental factors assessed in the review.

Conclusions

There is a lack of elaborate and detailed information in the literature regarding the factors considered in the development of apps used as interventions for diabetes self-management. Documentation and inclusion of such vital information will foster a transparent and shared decision-making process that will ultimately lead to the development of practical and user-friendly self-management apps that can enhance the quality of life for diabetes patients.

Secured remote health monitoring system

Wireless medical sensor network is used in healthcare applications that have the collections of biosensors connected to a human body or emergency care unit to monitor the patient's physiological vital status. The real-time medical data collected using wearable medical sensors are transmitted to a diagnostic centre. The data generated from the sensors are aggregated at this centre and transmitted further to the doctor's personal digital assistant for diagnosis. The unauthorised access of one's health data may lead to misuse and legal complications while unreliable data transmission or storage may lead to life threatening risk to patients. So, this Letter combines the symmetric algorithm and attribute-based encryption to secure the data transmission and access control system for medical sensor network. In this work, existing systems and their algorithm are compared for identifying the best performance. The work also shows the graphical comparison of encryption time, decryption time and total computation time of the existing and the proposed systems.

Ethics, Nanobiosensors and Elite Sport: The Need for a New Governance Framework

Individual athletes, coaches and sports teams seek continuously for ways to improve performance and accomplishment in elite competition. New techniques of performance analysis are a crucial part of the drive for athletic perfection. This paper discusses the ethical importance of one aspect of the future potential of performance analysis in sport, combining the field of biomedicine, sports engineering and nanotechnology in the form of 'Nanobiosensors'. This innovative technology has the potential to revolutionise sport, enabling real time biological data to be collected from athletes that can be electronically distributed. Enabling precise real time performance analysis is not without ethical problems. Arguments concerning (1) data ownership and privacy; (2) data confidentiality; and (3) athlete welfare are presented alongside a discussion of the use of the Precautionary Principle in making ethical evaluations. We conclude, that although the future potential use of Nanobiosensors in sports analysis offers many potential benefits, there is also a fear that it could be abused at a sporting system level. Hence, it is essential for sporting bodies to consider the development of a robust ethically informed governance framework in advance of their proliferated use.

Self-Organizing Peer-To-Peer Middleware for Healthcare Monitoring in Real-Time

As the number of elderly persons with chronic illnesses increases, a new public infrastructure for their care is becoming increasingly necessary. In particular, technologies that can monitoring bio-signals in real-time have been receiving significant attention. Currently, most healthcare monitoring services are implemented by wireless carrier through centralized servers. These services are vulnerable to data concentration because all data are sent to a remote server. To solve these problems, we propose self-organizing P2P middleware for healthcare monitoring that enables a real-time multi bio-signal streaming without any central server by connecting the caregiver and care recipient. To verify the performance of the proposed middleware, we evaluated the monitoring service matching time based on a monitoring request. We also confirmed that it is possible to provide an effective monitoring service by evaluating the connectivity between Peer-to-Peer and average jitter.

Ubiquitous Healthcare — Do the Health and Information Technology Sectors Converge?

Processes of convergence strongly influence the development of several industries and modern technologies as the example of convergence of the computer and telecommunication industry into one sector of information and communications technology (ICT) shows. These convergences are a substantial uncertainty for established companies in both established areas. Ubiquitous healthcare is a current trend in health technology which might be the expression of such a convergence. Therefore, the question whether this trend is an expression of an overall industry convergence between the ICT and the health sector is investigated in this study. Publication and patent data-based analyses are carried out for that purpose. An industry/technology sector classification as well as an IPC-co-classification analysis reveal clear signs of convergence between the ICT and health sector on the scientific and technology level. The results are critically discussed and theoretical and practical implications are given.

Patients' Data Management System Protected by Identity-Based Authentication and Key Exchange

A secure and distributed framework for the management of patients' information in emergency and hospitalization services is proposed here in order to seek improvements in efficiency and security in this important area. In particular, confidentiality protection, mutual authentication, and automatic identification of patients are provided. The proposed system is based on two types of devices: Near Field Communication (NFC) wristbands assigned to patients, and mobile devices assigned to medical staff. Two other main elements of the system are an intermediate server to manage the involved data, and a second server with a private key generator to define the information required to protect communications. An identity-based authentication and key exchange scheme is essential to provide confidential communication and mutual authentication between the medical staff and the private key generator through an intermediate server. The identification of patients is carried out through a keyed-hash message authentication code. Thanks to the combination of the aforementioned tools, a secure alternative mobile health (mHealth) scheme for managing patients' data is defined for emergency and hospitalization services. Different parts of the proposed system have been implemented, including mobile application, intermediate server, private key generator and communication channels. Apart from that, several simulations have been performed, and, compared with the current system, significant improvements in efficiency have been observed.

A Polynomial Subset-Based Efficient Multi-Party Key Management System for Lightweight Device Networks

Wireless Sensor Networks (WSNs) consist of lightweight devices to measure sensitive data that are highly vulnerable to security attacks due to their constrained resources. In a similar manner, the internet-based lightweight devices used in the Internet of Things (IoT) are facing severe security and privacy issues because of the direct accessibility of devices due to their connection to the internet. Complex and resource-intensive security schemes are infeasible and reduce the network lifetime. In this regard, we have explored the polynomial distribution-based key establishment schemes and identified an issue that the resultant polynomial value is either storage intensive or infeasible when large values are multiplied. It becomes more costly when these polynomials are regenerated dynamically after each node join or leave operation and whenever key is refreshed. To reduce the computation, we have proposed an Efficient Key Management (EKM) scheme for multiparty communication-based scenarios. The proposed session key management protocol is established by applying a symmetric polynomial for group members, and the group head acts as a responsible node. The polynomial generation method uses security credentials and secure hash function. Symmetric cryptographic parameters are efficient in computation, communication, and the storage required. The security justification of the proposed scheme has been completed by using Rubin logic, which guarantees that the protocol attains mutual validation and session key agreement property strongly among the participating entities. Simulation scenarios are performed using NS 2.35 to validate the results for storage, communication, latency, energy, and polynomial calculation costs during authentication, session key generation, node migration, secure joining, and leaving phases. EKM is efficient regarding storage, computation, and communication overhead and can protect WSN-based IoT infrastructure.

A Secure Region-Based Geographic Routing Protocol (SRBGR) for Wireless Sensor Networks

Due to the lack of dependency for routing initiation and an inadequate allocated sextant on responding messages, the secure geographic routing protocols for Wireless Sensor Networks (WSNs) have attracted considerable attention. However, the existing protocols are more likely to drop packets when legitimate nodes fail to respond to the routing initiation messages while attackers in the allocated sextant manage to respond. Furthermore, these protocols are designed with inefficient collection window and inadequate verification criteria which may lead to a high number of attacker selections. To prevent the failure to find an appropriate relay node and undesirable packet retransmission, this paper presents Secure Region-Based Geographic Routing Protocol (SRBGR) to increase the probability of selecting the appropriate relay node. By extending the allocated sextant and applying different message contention priorities more legitimate nodes can be admitted in the routing process. Moreover, the paper also proposed the bound collection window for a sufficient collection time and verification cost for both attacker identification and isolation. Extensive simulation experiments have been performed to evaluate the performance of the proposed protocol in comparison with other existing protocols. The results demonstrate that SRBGR increases network performance in terms of the packet delivery ratio and isolates attacks such as Sybil and Black hole.

Remote Blood Glucose Monitoring in mHealth Scenarios: A Review

Glucose concentration in the blood stream is a critical vital parameter and an effective monitoring of this quantity is crucial for diabetes treatment and intensive care management. Effective bio-sensing technology and advanced signal processing are therefore of unquestioned importance for blood glucose monitoring. Nevertheless, collecting measurements only represents part of the process as another critical task involves delivering the collected measures to the treating specialists and caregivers. These include the clinical staff, the patient's significant other, his/her family members, and many other actors helping with the patient treatment that may be located far away from him/her. In all of these cases, a remote monitoring system, in charge of delivering the relevant information to the right player, becomes an important part of the sensing architecture. In this paper, we review how the remote monitoring architectures have evolved over time, paralleling the progress in the Information and Communication Technologies, and describe our experiences with the design of telemedicine systems for blood glucose monitoring in three medical applications. The paper ends summarizing the lessons learned through the experiences of the authors and discussing the challenges arising from a large-scale integration of sensors and actuators.

Patterns-of-Life Aided Authentication

Wireless Body Area Network (WBAN) applications have grown immensely in the past few years. However, security and privacy of the user are two major obstacles in their development. The complex and very sensitive nature of the body-mounted sensors means the traditional network layer security arrangements are not sufficient to employ their full potential, and novel solutions are necessary. In contrast, security methods based on physical layers tend to be more suitable and have simple requirements. The problem of initial trust needs to be addressed as a prelude to the physical layer security key arrangement. This paper proposes a patterns-of-life aided authentication model to solve this issue. The model employs the wireless channel fingerprint created by the user’s behavior characterization. The performance of the proposed model is established through experimental measurements at 2.45 GHz. Experimental results show that high correlation values of 0.852 to 0.959 with the habitual action of the user in different scenarios can be used for auxiliary identity authentication, which is a scalable result for future studies.

Utilizing an Ingestible Biosensor to Assess Real-Time Medication Adherence

Medication adherence monitoring has relied largely on indirect measures of pill ingestion including patient self-report, pharmacy refills, electronically triggered pill bottles, and pill counts. Our objective is to describe an ingestible biosensor system comprising a radio-frequency identification (RFID)-tagged gelatin capsule. Once the capsule dissolves in the stomach, the RFID tag activates to transmit a unique signal to a relay device which transmits a time-stamped message to a cloud-based server that functions as a direct measure of medication adherence. We describe a constellation of mobile technologies that provide real-time direct measures of medication adherence. Optimizing connectivity, relay design, and interactivity with users are important in obtaining maximal acceptability. Potential concerns including gut retention of metallic components of the ingestible biosensor and drug dissolution within a gelatin capsule should be considered. An ingestible biosensor incorporated into a medication management system has the potential to improve medication compliance with real-time monitoring of ingestion and prompt early behavioral intervention. Integration of ingestible biosensors for multiple disease states may provide toxicologists with salient data early in the care of poisoned patients in the future. Further research on device design and interventions to improve adherence is needed and will shape the evolving world of medication adherence.