Service-Oriented Security Framework for Remote Medical Services in the Internet of Things Environment

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.

Secure Patient Authentication Framework in the Healthcare System Using Wireless Medical Sensor Networks

Biosensor is a means to transmit some physical phenomena, like body temperature, pulse, respiratory rate, electroencephalogram (EEG), electrocardiogram (ECG), and blood pressure. Such transmission is performed via Wireless Medical Sensor Network (WMSN) while diagnosing patients remotely through Internet-of-Medical-Things (IoMT). The sensitive data transmitted through WMSN from IoMT over an insecure channel is vulnerable to several threats and needs proper attention to be secured from adversaries. In contrast to addressing the security of all associated entities involving patient monitoring in the healthcare system or ensuring the integrity, authorization, and nonrepudiation of information over the communication line, no one can guarantee its security without a robust authentication protocol. Therefore, we have proposed a lightweight and robust authentication scheme for the network-enabled healthcare devices (IoMT) that mitigate all the identified weaknesses posed in the recent literature. The proposed protocol's security has been analyzed formally using BAN logic and ProVerif2.02 and informally using pragmatic illustration. Simultaneously, at the end of the paper, the performance analysis result shows a delicate balance of security with performance that is often missing in the current protocols.

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.

Security Requirements of Internet of Things-Based Healthcare System: a Survey Study

Introduction:

Internet of Things (IoT), which provides smart services and remote monitoring across healthcare systems according to a set of interconnected networks and devices, is a revolutionary technology in this domain. Due to its nature to sensitive and confidential information of patients, ensuring security is a critical issue in the development of IoT-based healthcare system.

Aim:

Our purpose was to identify the features and concepts associated with security requirements of IoT in healthcare system.

Methods:

A survey study on security requirements of IoT in healthcare system was conducted. Four digital databases (Web of Science, Scopus, PubMed and IEEE) were searched from 2005 to September 2019. Moreover, we followed international standards and accredited guidelines containing security requirements in cyber space.

Results:

We identified two main groups of security requirements including cyber security and cyber resiliency. Cyber security requirements are divided into two parts: CIA Triad (three features) and non-CIA (seven features). Six major features for cyber resiliency requirements including reliability, safety, maintainability, survivability, performability and information security (cover CIA triad such as availability, confidentiality and integrity) were identified.

Conclusion:

Both conventional (cyber security) and novel (cyber resiliency) requirements should be taken into consideration in order to achieve the trustworthiness level in IoT-based healthcare system.

Identification of key factors in consumers' adoption behavior of intelligent medical terminals based on a hybrid modified MADM model for product improvement

BACKGROUND

As a new application technology of the Internet of Things (IoT), intelligent medical treatment has attracted the attention of both nations and industries through its promotion of medical informatisation, modernisation, and intelligentisation. Faced with a wide variety of intelligent medical terminals, consumers may be affected by various factors when making purchase decisions.

PURPOSE

To examine and evaluate the key influential factors (and their interrelationships) of consumer adoption behavior for improving and promoting intelligent medical terminals toward achieving set aspiration level in each dimension and criterion.

METHOD

A hybrid modified Multiple Attribute Decision-Making (MADM) model was used for this study, based on three components: (1) the Decision-Making Trial and Evaluation Laboratory (DEMATEL) technique, to build an influential network relationship map (INRM) at both 'dimensions' and 'criteria' levels; (2) the DEMATEL-based analytic network process (DANP) method, to determine the interrelationships and influential weights among the criteria and identify the source-influential factors; and (3) the modified Vlse Kriterijumska Optimizacija I Kompromisno Resenje (VIKOR) method, to evaluate and improve for reducing the performance gaps to meet the consumers' needs for continuous improvement and sustainable products-development. First, a consensus on the influential factors affecting consumers' adoption of intelligent medical terminals was collected from experts' opinion in practical experience. Next, the interrelationships and influential weights of DANP among dimensions/criteria based on the DEMATEL technique were determined. Finally, two intelligent medicine bottles (AdhereTech, A₁ alternative; and Audio/Visual Alerting Pillbox, A₂ alternative) were reviewed as the terminal devices to verify the accuracy of the MADM model and evaluate its performance on each criterion for improving the total certification gaps by systematics according to the modified VIKOR method based on an INRM.

RESULTS

In this paper, the criteria and dimensions used to improve the evaluation framework are validated. The systematic evaluation in index system is constructed on the basis of five dimensions and corresponding ten criteria. Influential weights of all criteria ranges from 0.037 to 0.152, which shows the rank of criteria importance. The evaluative framework were validated synthetically and scientifically. INRM (influential network relation map) was obtained from experts' opinion through DEMATEL technique shows complex interrelationship among factors. At the dimension level, the environmental dimension influences other dimensions the most, whereas the security dimension is most influenced by others. So the improvement order of environmental dimension is prior to security dimension. The newly constructed approach was still further validated by the results of the empirical case, where performance gap improvement strategies were analyzed for decision-makers. The modified VIKOR method was especially validated for solving real-world problems in intelligent medical terminal improvement processes. For this paper, A₁ performs better than A₂, however, promotion mix, brand factor, and market environment are shortcomings faced by both A₁ and A₂. In addition, A₂ should be improved in the wireless network technology, and the objective contact with a high degree of gaps.

CONCLUSIONS

Based on the evaluation index system and the integrated model proposed here, decision-makers in enterprises can identify gaps when promoting intelligent medical terminals, from which they can get valuable advice to improve consumer adoption. Additionally, an INRM and the influential weights of DANP can be combined using the modified VIKOR method as integrated weightings to determine how to reduce gaps and provide the best improvement strategies for reaching set aspiration levels.

PP156 New Information And Communication Technologies And Hospitals' Design

INTRODUCTION:

The hospital's design today must be prepared for changes resulting from the incorporation of new information and communication technologies (ICT) (1). These will affect non-finalistic (warehouse, archive), diagnostic support (laboratory and image) and finalistic activities (emergency, surgical center, clinics) (2). The Health Technology Assessment (HTA) is fundamental in the dimension of the impact of each technology on the structure of healthcare facilities (HCF). In this way, this work intends to evaluate the trends of impact of the new ICT on hospitals’ structure.

METHODS:

The main technologies under discussion in Management of HCF in Brazillian Health Regulatory Agency were raised. From this survey an impact matrix was built with hospital environmental design and the trends of adequacy of its space.

RESULTS:

ICT that tend to decrease the physical space are: electronic health record for the archive, use of digital imaging for radiology, Radio-Frequency Identification (RFID) for the warehouse, point of care and automated laboratory equipment for clinical laboratories.

ICT that tend to increase physical space are: Telemedicine for the surgical center, Internet of Things - IoT for Intensive Care Units, beds for emergency and hospitalization.

The technologies that present an undefined tendency in relation to physical space are: automatic dispensers of drugs for nursing posts.

The use of database servers and the need for network points are still undefined due to the use of Wi-Fi technology and cloud storage. However, it's possible to increase use of electricity and the internet.

CONCLUSIONS:

It is concluded that the new ICT will have an impact on the planning and building of the future HCF (3). The designs of today's buildings should consider this trend so that the future reality is adequate and the regulatory requirements about HCF should be able to consider it.

PP064 Registration Of Healthcare Mobile Apps In Brazil

INTRODUCTION:

The use of applications (app) on mobile phones to health care is a trend. Its applications range from the use as energy calculators, monitoring clinical parameters, as well association with medical devices, personal health records or used to request appointments (1). Thus, it is intended to evaluate the regulatory instruments available in Brazil as to their sufficiency to analyze this new technology.

METHODS:

Assessment of regulatory instruments for mobile app registration by the Brazillian Health Regulatory Agency (Anvisa) (2). The main variables in the form of Class I and II are: Submission type, Postal Code, Electronic Site, Product code, Classification Rule, Class, Indication of Use / Purpose, Principle of Operation, Platform, Target Audience, Type of Environment, Compatibility, Safety Characteristics, Technical Standards used, Product Origin.

RESULTS:

Since 2010, the registration of software in Anvisa has been observed. The evaluation of Class I and II software is performed through the registration analysis to be completed by the requesting company. Class III (high risk) software is registered as a medical device embedded software (2).

Anvisa's analysis of the software still depends directly on the application for registration of the companies. In this way most of the analyzed software are for use by health professionals and health services.

CONCLUSIONS:

There are Brazilian regulations for health products with software registration forecast, however its use as a health service still lacks studies mainly with the trends of new information and communication technologies (3).

The regulation of mobile applications becomes difficult because applications are freely downloaded in virtual stores, their domains are usually in foreign territory and their use is given directly by the user.