Internet of Things for Smart Healthcare: Technologies and Prospects

This literature review explores the application of the Internet of Things (IoT) in smart healthcare, focusing on technologies, challenges, and opportunities. It highlights the increasing importance of IoT devices, particularly wearable sensors, in monitoring patient health and providing real-time data for medical professionals. The review emphasizes the critical need for data security in IoT healthcare systems and proposes a novel authentication process for IoT devices using the CoAP protocol and ECC encryption to address resource constraints and enhance security. It discusses existing authentication technologies and their limitations, emphasizing the importance of resource-efficient algorithms for IoT environments. The review concludes by advocating for the development of advanced, secure, and resource-conscious IoT solutions to improve healthcare outcomes, providing a comprehensive overview of the current state and future directions of IoT in the healthcare sector.

Internet of Things for Smart Healthcare: Technologies, Challenges, and
Opportunities
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Abstract
In the current context the Internet of Things has become a very important domain where the
sensors and the embedded systems are capable of connect to each other and are also capable
of exchanging data among them. The IoT devices has gained so much importance in the last
few decades as this has provided many advantages to most of the industries and sectors which
includes the healthcare sector also. The data of the IoT is very much critical so it must be
ensured that the data are always secured from external threats and hackers. Thus in this
aspects the security constrains are very much important to keep the data of IoT safe from the
hackers and the intruders. The nature of the IoT devices as a resource requires authentication
process for the data retrieval and this process of authentication does not requires a high
computing power. Thus getting a brief aspects of the IoT devices in this paper a brief
discussion has been done on the usage of IoT in the healthcare sector. Here a brief discussion
has been done on the IoT and its importance regarding the development of the wearable
devices that can track the health regarding aspects of the human body.
Also, in the aspects of IoT in the healthcare industry a novel authentication process has been
proposed for the IoT devices. It has been assessed that the proposed architecture is capable of
providing a secure and a structure which is very much important for the healthcare sectors. In
this aspects the CoAP protocol has been dominated by the ECC algorithm, thus CoAP has
been used in this case.
The proposed algorithm has integrated 256 bit encryption which ensures higher security than
previous models. Systems that provided 256 bit encryption has one problem and that is slow
authentication speed. This proposed algorithm is light on resource and hence requires less
time for authentication which is significant improvement than previous models.
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The proposed mechanism of authentication is capable of providing an authentication
procedure with some high security. In previous proposed mechanisms, either designs were
not so accurate or it was so complex that it is not suitable for IOT environment.
Consideration of resource constraint in designing algorithm makes this proposed algorithm
different from another authentication algorithm as propped by other authors in their previous
research.
Keywords:
IOT, technology in healthcare, encryption, data security, resource constraint
Introduction
In this paper, the usage of the IoT for application in the healthcare sector and importance of
security along with resource constraint in IOT has been considered. Application and security aspect of
IOT has been reviewed and has been presented. From the discussion, it has been assessed that EEC
keys are capable of reducing the calculation requirement while it provides some powerful encryption
process and it is better compared with many types cryptography encryption procedures.
The wearable sensors are one of the most important and efficient devices in the aspect of
internet of things in health care devices (Azzawi, Hassan & Bakar, 2016). The wearable sensors has
become very much important in the current technological aspects as it provides accurate information
about a health of a patient (Javdani & Kashanian, 2017). The main purpose of this system is
effectively monitoring various of aspects of human body in real time which includes blood pressure,
heart rate, flow of oxygen, etc. This system achieves its purpose of gathering the data regarding
human body through its integrated sensors which is directly connected with the human body.
The main technology that has been used in this case is the wearable device technology which
effectively monitors biological aspects of the human body in the healthcare sector and for that IoT has
been leveraged in this case (Sankar, & Srinivasan, 2018). In the generic domain of healthcare system
this technology is used for measuring the blood pressures, heart rate, body temperature and many
more things (Govinda & Saravanaguru, 2016). This technology is also very much useful for in the sub
domain of surgeries as this can provide information of the human body on a real time basis which is
very much important to monitor during the operating hours on a patient (Cook et al., 2018). The main
limitation in this case using a wearable gadget during the operation is not suitable.
The main objective of this project is making the healthcare sector more advance so that that
various risks in this sector can be minimised and more better health can be provided to the patients
(Azzawi et al., 2016). Classification of the used components is very much important so that they so
that the users can effectively understand how this system works actually. The main gap in this case is
that previous wearable devices were capable of measuring some basic properties of human bodies but
in this case the proposed device is more advanced and it is capable of measuring the blood pressure
also of the human bodies which is actually a hard task (Gubbi et al., 2015).
In this case the previous solutions has been chosen regarding development of the wearable
devices for gaining an idea about the wearable devices in the context of healthcare devices and what
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type of innovation has been done so far in this sector (Mishra et al., 2016). Some of the papers has
been chosen out of a vast number of papers for the proceeding with the further research as the selected
paper was having more relevancy with domain of the research while the other papers were only
having some basic information about the wearable device (Zhang et al., 2014).
For organizing the paper perfectly first the existing technologies on the wearable technologies
must be evaluated properly. Then a survey has been taken of a hospital which uses this technology
and it is asked to them that how this technology has affected them and their responses has been
recorded (Khoo, 2015). In the further cases a brief analysis has been done on the responses and from
there further discussion has been started.
The wearable technology in the healthcare sector is sort of some advanced devices which can
effectively track the healthcare record of the humans on a real time basis (Jing et al., 2014). This
technology helps to monitor various of aspects of a human body which includes body temperature,
heart rate monitoring and many more other aspects (Kim, 2017). In the domain of healthcare industry
this is having a huge importance as this helps the doctors to determine the health conditions quickly
without much effort (Tewari & Gupta, 2017). This can be very much helpful for the emergency cases.
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Literature Review
Previous work:
According to u Farooq et al. (2015) Most of the previous researches that has focused on
integrating IOT for application in healthcare that has only directed the focus on
authentication technology. However, algorithm proposed in this context is not analysed in
terms of resource constraints, which is an important criteria to consider, as resource
constraint is an important issue in the IOT environment (Yaqoob et al., 2017). however as
identified in the analysis , it is seen that no dedicated effort has been provided by the previous
researchers and hence there is a requirement to conduct extensive research on this aspect as
without properly identifying solution for dealing with resource constraints in the IOT
environment, it is not possible to propose effective authentication algorithm for IOT
application (Hassanalieragh et al., 2015). Here in this context, an authentication algorithm has
been proposed that addresses authentication issues in IOT environment and this proposed
algorithm is also light on resource, as it does not require extensive computing resources and
computing power.
YANG, Hao & ZHANG (2016) have proposed a mutual authentication model for securing
devices in IOT environment. It is a modification of existing authentication protocol that is
based on RFID technique, which is applicable for database implemented in distributed
environment. The modification has been made to match with IOT environment and. It
consists of three important components such as backup for each terminal devices integrated
for controlling, integration of devices that monitors this controlling application and
integration of an alarm system to notify about any issues in the authentication process.
In another research paper, the authors have provided two phase authentication protocol. It is
a certification based authentication protocol. This protocol allows in two way authentication,
which means with this technology, it is possible to authenticate both the IOT devices and the
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controlling station as well and allow for mutual communication, and authentication at the
same time.
In this research paper, the authors have proposed for an authentication algorithm that is based
on Elliptic Curve Cryptography (ECC). According to the authors, this method is more
secured and efficient as well compared to public key cryptography, which is not that secure.
The authors also specify that when considering application on healthcare sector security
needs to be ensured properly. Elliptic Curve Cryptography (ECC) as mentioned by the
authors has smaller key seize and hence appropriate for IOT based application. This protocol
has three main components that is Registration phase, Pre-computed and login phase and
authentication phase. In Pre-computed, login phase, and authentication phase, the IOT
devices need to send a login request for authenticating with the server. Authentication of the
IOT devices with the server is decided in the authentication phase. Once authentication of the
devices are established with the server, the devices are then allowed to login to the system
and access system data through internet.
In their research, Mahalle, Prasad, & Prasad (2014) have provided "Threshold Cryptography-
based Group Authentication (TCGA) scheme for the Internet of Things (IoT)," for securing
IOT devices. Here authentication of the IOT devices are done on group communication
model. However, this model of authentication is only applicable for Wi-Fi environment.
Hence, this model is not possible to extend to environment where different communication
technology is considered.it generates a secret key for which is also known as session key.
Different session key is generated for different group communication so that it is possible to
manage each group communication independently.
S. R. Moosavi et al. (2015) have proposed for SEA, which is a “Secure, and Efficient
Authentication and Authorization Architecture” for IoT-Based Healthcare and this
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mechanism is developed with Smart Gateways. This mechanism is based on “certificate-
based DTLS handshake protocol”.
Proposed system:
According to Hossain, Fotouhi, & Hasan, R. (2015) Although ECC encryption algorithm
reduce he key size, it does increases the message size significantly. Along with that, it is also
important to recognize that ECC algorithm has better authentication protocol than other
cryptographic algorithm such as public key cryptography, but it is complex to implement
(Bui & Zorzi, 2015). As already mentioned, one of the aspects that makes IOT a challenging
field for composing authentication algorithm, is that resources and computing power is very
limited (Lee, 2015). IOT devices are often equipped with very less memory and hence
execution of sophisticated authentication algorithm is not possible and hence alternative yet
effective authentication algorithm is required that not only address security challenges of IOT
devices, but also consider resource constraint of IOT devices (Perera, Liu & Jayawardena,
2015). Hence in this context an efficient authentication algorithm is proposed that is based on
Constrained Application Protocol (CoAP) and Elliptic Curve Cryptography. This CoAP
model is based on authentication mechanism proposed by Z. Shelby, K. Hartke, and C.
Bormann, "The constrained application protocol (CoAP)," 2014. and ECC based mechanism
is proposed by V. Kapoor, V. S. Abraham, and R. Singh, "Elliptic curve cryptography,"
ACM Ubiquity, vol. 9, pp. 20-26, 2014.
CoAP is based on IETF working group of Constrained Restful Environment (CoRE).
Constrained Restful Environment (CoRE) provides an effective architecture that is consistent
with the constraint nature of sensors nodes. CoAP provides an efficient context, which makes
it possible for these constrained nodes in providing mechanism that is required to implement
web transfer, and one significant benefit is that it allows for secure IoT communication. The
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propose algorithm deploys three different protocols that are integrated with IOT protocol
stack. These three stacks include CoAP, MQTT and XMPP and it includes 6LoWPAN. This
protocol as provided is specially designed for environment with limited resources for
application. Hence, this protocol is consistent with the IOT environment.
Another technology that is available for communication over internet, an important feature in
IOT enabled network, though it is not considered here for some specific reasons. While
CoAP allows machine to work in two different mode that is as client and as a server. One
important feature of CoAP that makes this protocol secured than the HTTP technology is that
communication of message in CoAP is executed in asynchronous manner, which increases
security of application. In this proposed mechanism, an additional request/response layer is
added which increases security of the communication.
Both CoAP and ECC protocol has some benefits as well as some drawback and hence the
proposed mechanism has combined both this protocol. An ECC authentication mechanism
over CoAP connection has been deployed here. Combination of both these protocols has
helped in optimizing overhead associated with IOT network. Due to this, it is possible to
reduce communication and processing power that is required for IOT device authentication,
which ensures enhanced security.
The proposed authentication method consist of four stages that is required for execution of
this algorithm.
Stage1: it is the initialization phase. Here Control system provides a private key along with a
public key that is required for communication using ECC.
Stage2: registration of the devices is done in this phase. This phase includes the pre
authentication process where it is checked if the device in consideration is already
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authenticated with the IOT network or not and this process is done over CoAP. Control
station, which is an important part of the network, checks the associated device ID to identify
if any corresponding entry has been considered for it. If this is not done, in order to
authenticate the devices, a strong password is generated with associated device ID that is
unique for a specific device. The private key generated in this process acts as a password for
encryption and this password is stored in the IOT devices.
Stage3: it is also known as Mutual authentication stage. IoT enabled device, needs
appropriate password for generation of authentication key. Once the process to generate
authentication key is completed, it is then sent to control system. This is executed when the
control system try to connect with the server. Control system generates this authentication
key and corresponding IOT entries is stored in the control system that is associated with the
IOT device.
Stage4: all traffic that pass between different IoT devices and control station is secured with
encryption. This encryption is done to provide protection to the IOT devices from various
cyber security crimes that are often targeted at IOT devices for easy vulnerability and ease of
execution due to lack of proper security measures.
Consideration of resource constraint in designing algorithm makes this proposed algorithm
different from another authentication algorithm as proposed by other authors in their previous
research. Most of the research papers on this topic has described one factor for IOT
environment and that is security of information. Although security of IOT devices are
important, it is important to note that only increasing authentication bit is not enough, it is
required to consider authentication speed as well. In addition to that, consideration of
resource constraint is also an important design constraint. Hence, improvement is required in
algorithm design, which provide motivation for this research.
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Proposed System Components
The authentication mechanism based on CoAP and ECC algorithm has been developed with
review of past as well present authentication protocol that has been applied in IOT
environment so far. In order to develop this system, practical experience and knowledge has
been considered as well. Assistance from security experts specialized in IOT based security
applications has been taken for developing this proposed mechanism for security of IOT
devices. It has also included criteria for evaluating proposed system based on applicability
and effectiveness of this proposed authentication algorithm. These factors are important for
development and validation of this developed system for effective evaluation.
The search for the relevant article has provided 440 result of which 105 papers were selected,
as these articles were in accordance with the search criteria. These articles have described
security issues in IOT environment. 40 article have described need for security mechanism in
IOT environment. 30 articles have described about resource constraints in IOT environment.
35 articles have described about both resource constraints and integration with authentication
protocol. Others articles were rejected as they were not relevant to the topic. 270 articles have
only described about application of IOT in reference with healthcare sector, which is not
research of interest here. 55 articles have only discussed about security issues in IOT without
any proposed solution. 45 articles have not even considered healthcare sector for application
of IOT. 20 articles were based on application of IOT in smart city, another 20 articles were
about IOT in logistics and 5 articles were about application of IOT in transportation system
with
Base one the analysis and previous knowledge in this field implies that, in order to have
proper application of IOT in medical context, three main points should be considered:
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1) What are the available option for data acquisition regarding patient medical
information
2) How data should be secured
3) How data should be distributed with data availability and data integrity
The first factor that is considered in this CoAP and ECC based authentication mechanism is
data. It includes data such as patient medical history, medicine information with the
properties of dimensionality, modality, semantic and it is considered to identify if data has
been properly allocated. Then authentication protocols that are considered are deployed for
data encryption for data security. Next, data distribution is considered for making data
available for proper application.
Factors Main attributes Common instances
Data Dimensionality 2D, 3D
Raw patient data Acquisition techniques Data communication, sever
connection
Data encryption Algorithm CoAP, ECC, SEA
Data distribution Location Distributed database
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