A Comprehensive Analysis of IoT in Healthcare: Security and Trends

This report provides a comprehensive overview of the Internet of Things (IoT) in healthcare. It begins with an abstract highlighting the importance of IoT and the need for robust security and authentication methods for the data generated by IoT devices. The introduction emphasizes the growth of IoT, its applications in healthcare, and the critical security concerns associated with its use. The literature review explores various clinical applications of IoT, including remote healthcare monitoring and the challenges researchers face in developing secure authentication mechanisms for diverse IoT devices like smartwatches and thermostats. The report discusses physical protection solutions and cryptography-based authentication, including the use of RFID and the limitations of existing authentication approaches such as HTTP and AES protocols. The related work section presents various authentication protocols proposed for IoT devices, including enhanced mutual authentication models, two-phase authentication protocols for wireless sensor networks, lightweight mutual authentication schemas, and ECC-based secure authentication schemas, and threshold cryptography-based group authentication. The report concludes by discussing a secure and efficient authentication and authorization architecture for IoT-based healthcare using smart gateways.

IoT in Healthcare
[Name of the author]
[Designation of the Author]
[Available at]

ABSTRACT – IoT or the Internet of Things is considered as a powerful rising domain, which is associated with the
various type of embedded devices or sensors. This sensors or embedded devices have the capability of connecting
themselves and exchange the information over the internet. The use of the IoT devices are increasing day by day and the
data provided by this devices are also critical. For this reason, it is very essential to have certain security constraints,
which would be helping in the securing of the data along with special authentication schemes, which are not associated
with the consumption of the high computing as well as the energy resources. This paper would be mainly discussing
about the IoT healthcare usage. A literature review has been conducted in this report regarding the usage of the IoT in
healthcare besides this the report also discusses about the past and the present works done with the IoT in healthcare.
1. INTRODUCTION (15 MARKS)
Internet of things or the IoT can be considered as one of the
most common research topic. The growt of this technology
has been greatly favored by the various type of advancements
that has occurred in the field of electronics, IPv6 and the
wireless networks [1]. The use of IoT has greatly increased
and it is being used in various environments, which includes
the homes, healthcare, and many more. Besides this various
type of approached have been proposed which can be used for
eth purpose of controlling the IoT devices. The major concern
regarding the use of the IoT includes the various type of
security issues. The security concerns are to be kept in the
highest priority and should be first topic for the research [2].
The interest of body wearable is increasing day by day
which is acting as a powerful tool for different application of
healthcare and also the different devices. Different IoT
devices are available which are currently being used for
various purposes which mainly includes the personal
healthcare, awareness regarding various activities and fitness.
2. BACKGROUND/LITERATURE REVIEW
Various researchers have been associated with proposing
new techniques of clinical application of the IoT technology.
This technology has greatly helped in remote healthcare
monitoring along with functionalities for long-term recording
of the health statues [3]. It has been seen that most of the
remote health care frameworks, which has been proposed,
consists of three tiers and this includes the body sensor
network tier, communication and networking tier and lastly
the processing and the analyzing nodes. The first tier or the
body sensor network tier mainly includes the various wearable
sensors, which works like as the unit for data acquisition. The
second tier or the communication and the networking and the
services are associated with the collection of the data from the
sensors and then forward the data to the next tier [4][5]. The
last tier, which is associated with the processing and analyzing
of the nodes [6][7].
Most of the researchers have been facing a certain
challenges. The main challenges which the researcher are
facing while proposing new authentication mechanism but
also while proposing new authentication mechanism that
would be responsible for supporting the different kinds of IoT
devices [8]. The authentication standards that the smart
phones are having would be applicable for the smart devices
as well. By smart devices, we mainly mean the smart watches,
smart thermostat and many more [9].
The researchers have been capable of proposing two main
device identity security solutions, this mainly includes the
Physical protection solution, and the cryptography based
authentication solution [10]. The main purpose of designing
the physical protection approach is for protecting the device
from being damaged or attacked at the level of the physical
layer and this is mainly done application of the various
physical concepts [11]. Along with this, the cryptography
based authentication approach is mainly designed by making
use of the IoT Based RFID in the field of security. Besides
this it also consists of various features and different
algorithms has been proposed which are based upon the IoT
RFID [12].
There exists limited number of resources in the IoT devices
and all this are connected to the resources. This ultimately
makes the devices vulnerable to various kind of risks and the
devices become vulnerable to this attack [13]. In order to
guarantee the security and also to identify the identities
authentication is needed and this would be helping in
preventing the attackers and other type of malicious attacks
[14]. High resources are required for the processing in the
traditional authentication methods. Besides this, the IoT is
also considered as a constraint resource environment, which is
having a limited number of resources. Along with this, a
lightweight authentication approach assisted by the robust
security features which is generally required for preserving the
energy and to fit the processing capabilities [15][16].
Some of the latest authentication approach have been used
for the purpose of providing a secure communication. The
approaches have been associated with the use of the HTTP
protocol in order to authenticate the communication suffer
[17]. In addition, this is done from the high overhead, which is
resulted from the usage of the HTTP protocol. This HTTP
protocols are not at all optimized for the IoT environment,
which are having limited resources. Whereas the other
approaches are associated with the usage of the AES in order
to encrypt the communication [18]. The AES is associated
with the usage of the long encryption keys along with the
complex calculations which are ultimately resulting in the
high consumption of the power and are also not fitted for the
requirements of the IoT energy resources which are restricted
[19].
2.1 Related work

Various types of authentication has been proposed for the
purpose of providing the authentication that is required by the
IoT devices [20]. An enhances mutual authentication model
was proposed by [18] for the IoT environment. Besides this,
they were also associated with providing a some suggestions
regarding the improvement of the algorithm associated with
authenticating the RFID authentication protocol, which is
based upon the challenge response present in the distributed
database environment. This ultimately resulted in making the
proposed architecture much more suitable for the IoT control
system environment [21]. Three main steps are included in
this approach and this includes the add backup device for
each terminal devices used for controlling, add monitor
devices to follow and monitor terminal devices and finally add
a push in alarm mechanism for alarming for any failed
authentication process.
Whereas a Two-Phase Authentication Protocol was
proposed by [22] for the Wireless Sensor Network present in
the Distributed IoT application. This protocol can be stated as
the certificate based authentication approach. The two phase
authentication is associated allowing both the IoT devices as
wella s the control station in order to authenticate and
recognize each other. Besides this a secure connection was
also established and the transfer of the data was done in a
secure way. They were also associated with using the protocol
supports resources limitation of the sensor nodes and had also
considered the network scalability and heterogeneity. Besides
this the CA or the Certificate authority was used for the
purpose of issuing the certificates. Once a certificate is
received then the existing nodes would be capable of moving
and changing their location. The CA would also be helping in
the validation of the identity of the sensors and
communicating with the other entities present at the network.
Before initializing a connection the team members need to
connect to the CA first in order to confirm the identity of the
destination. The approach has also been considered as an end-
to-end application layer authentication approach and is also
dependent on the other security features present at the lower
layer.
A light weight mutual authentication schema was proposed
by [23] in order to validate the identities in the IoT devices
which are associated with participating in the environment
before participating in the network. Along with this they also
proposed a decreased communication overhead. They were
also associated with choosing a Constrained Application
Protocol (CoAP) as a under layer protocol in order to provide
communication that exists between the various IoT devices.
The process of authentication has been completed by making
use of the 128-bit AES or the Advanced Encryption Standard.
After this an identification of the client and the server is done
at the first step. Followed by this is the providing of different
resources to the clients which are based upon certain
conditions that are determined according to the request. The
transmission of the condition specific data is associated with
minimizing the number of transmitted packets. The ultimate
result is the reduction of the energy consumption and the
computation.
A secure authentication schema for the IoT was proposed
by the [24] which was mainly dependent on the ECC or the
Elliptical Curve Cryptography based algorithm which is
associated with supporting the security solutions which are
better. This happens when it is compared with the other type
of PKC or the Public Key cryptography algorithm due to the
small size of the keys [25]. Besides this the authentication
protocol is used by the EEC for the embedded devices which
in turn makes use of the HTTP protocol. By making use of the
cookies of the HTTP authentication of the smart devices are
done and this a novel approach. All these devices needs to be
configured by making use of the TCP/IP. The Proposed
Authentication Protocol was designed for the purpose of using
the HTTP cookies which are to be implemented in order to fit
the embedded devices which are having the constrain
environment and are controlled by the cloud servers. Three
phases are included in the proposed protocol and the phase
includes the phase of registration, phase of the pre-
computation and the phase of login. The phase of registration
mainly includes the embedded devices which registers
themselves with the cloud servers and this in turn is associated
with sending back of the cookies that are generally stored in
the embedded devices. Whereas in the pre-computational and
the login phase the devices have been associated with
connecting with the server and they need to send a request for
login [26]. Lastly, in the authentication phase the embedded
devices as well the cloud servers have to mutually
authenticate themselves by making use of the EEC algorithm.
Instead of having small encryption key this has been
associated with increasing the size of the encrypted message
in a significant way. Besides this the ECC algorithm is very
much complex along with being difficult for implementation
when compared with the other cryptographic algorithms and
they also require much more processing resources.
A Threshold Cryptography-based Group Authentication or
the TCGA was proposed for the IoT in [27]. This model has
been associated with providing an authenticity for the IoT
devices which is mainly based upon the communication model
of the group. Besides this the TCGA is also designed for the
purpose of implementing it in the Wi-Fi environment. Besides
this it is also associated with creating a secret channel or
session keys for authenticating each group and this in turn can
be used for the purpose of group applications. There exists a
group head in each group and they are responsible for the
generation of the keys and followed by the distribution of the
new keys every time whenever a new member gets added for
the purpose of preserving the leakage of the group keys. This
group head is generally referred to as the group authority.
There exists five main modules and this mainly includes the
distribution of the keys, updating of the keys, generation of
the group credits, authenticating the listener and decryption of
the messages.
According to [28] SEA or the Secure and Efficient
Authentication and Authorization Architecture for the IoT
based healthcare was proposed by making use of the Smart
Gateways. This architecture was mainly based upon the
certificate-based DTLS handshake protocol. The following

parts have been included in the Architecture and this mainly
includes the medical sensors network which are associated
with the gathering of the information from the body of the
patients or from a room of the patient which would be
followed by helping in the process of treatment and medical
diagnosis. The second component mainly includes the Smart
e-Health Gateway which is associated with enabling the
various systems responsible for communication which would
be acting as an immediate for the MSN and also for the
internet. Lastly the third part includes the Back-end system
which are associated with receiving, processing and storing of
the information which are collected.
New CoAP option was proposed by [29]. This CoAP is
associated with working at the application layer which is
associated with providing the ability of retrieving the data
from devices. This data might include the metadata and the
measurement of the sensors. This information are used by
different real-time applications. However, sometimes it is a
security requirement to not retrieve the raw communication
data. However only the abstractions, which also includes the
high level state of the observed entities. Additionally along
with the nature of the resource constrained devices might be
accesses by anyone by making use of the internet, reduction of
the consumption of energy also plays a vital role. The
proposed option would be helping in reducing the messages
numbers while observing the sensor resources and this would
be resulting in the reduced consumption of the energy along
with increasing the lifetime of the devices.
The highest concern in the developing mainly includes the
prevention of the exhaustion of the resources. This resources
are responsible for the restriction of the nature of the IoT
environment devices and mainly requires authentication
mechanisms which would be fitting the limited memory,
processing and the energy of the IoT devices [30]. The
research proposal is associated with providing an
authentication mechanism which is mainly dependent on the
CoAP and the Elliptic Curve Cryptography or the ECC [30].
3. ISSUES/SOLUTIONS/FINDINGS
3.1. IOT security
The use of internet of things in healthcare is
increasing as it helps in well-versed decisions and helps in
providing on time treatment. The use of IoT in healthcare
helps in real time alerting, tracking and monitoring of the
patients and the patients’ data and thus improve the accuracy
of healthcare services provided to the patients. This is one of
the significant reasons of increase in the usage of IoT in
healthcare.
Figure 1: IOT applications in Healthcare
However, there are certain issues and risks associated with
the use of IoT in healthcare. The increase in the information
flow results in increase in certain risks that the health care
professionals need to address. Although there are a number of
benefits that are associated with the connected devices, there
are certain new risks and vulnerabilities that are needed to be
addressed. One of the significant risks is unauthorized access
to the data of the patient as any modification in the data of the
patients might threaten the safety of the patients. The main
reason of the increase in risk associated with the use of IoT
devices is healthcare is the use of different devices that is
entering into the hospital through a variety of channel. The
chances of malware being spread through these devices are
very high. Apart from that, there is a significant threat in the
patient monitoring and control [39]. The great benefit of the
using IoT in health is that the remote monitoring of the health
condition of the patients is possible. This is a great help for
the patients who face difficultly in visiting the hospital.
However, if any attacker is able to disrupt the monitoring and
the communication signals exchanged between a patient and a
doctor, it might result in serious health implications.
Apart from monitoring, certain IoT devices have specific
functions such as dispersion of the medications based on the
health condition of a patient. The use of the connected devices
automatically monitors the blood sugar level of the patients
and injects insulin when required. If any of such device is
infected by the malware it will pose a significant risk of the
life of the patients. Furthermore, an intruder might hack into
the system with an intension of infusing lethal doses to the
patients. Apart from that, the disruption of the technology and
denial in the service might be able to block the technology
from proper functioning. Therefore proper monitoring of the
IOT devices is necessary.
The electronic health implant device such as pacemakers is in
use for many years. However, with the improvement of the

technology, the need of receiving data from those devices
increases as well [38]. The modern pacemakers are equipped
with wireless features that allow proper transmission of the
monitoring and the related diagnostic data. The main risk here
is the loss of life. This is because if a pace maker device is
compromised; it might disrupt the normal operations of the
machine. The attacker can send dangerous commands that
might disrupt the normal operation of the device [35].
Therefore any security threat in IoT network might pose
significant risk in life of the patients. Therefore, it is very
essential to address the different security risks and issues
associated with the use of the IoT and healthcare. The
complexity of the Internet of Things and its application in
healthcare magnifies the cyber security risks or threats
associated with the use of internet of things. The solutions to
the identified problems or the issues associated with the use of
IOT devices is needed to be identified. Solution to the
problem is necessary to be evaluated as the identified risks or
problems can be a dangerous threat to the healthcare or lives
of the patients.
3.1.1. Solutions to the identified risks
The solutions to the data security risks associated with the use
of IoT in healthcare is needed to be evaluated. Network
security is essential to consider since it might risk the life of
the patients. The network security issues associated with the
use of IoT can be mitigated by end to end security. The secure
socket layer network can help in establishing an end to end
secure networking option as it will help the IoT device and the
server in communication securely. The use of secure socket
layer can help in prevention of the data being exposed to a
third party. Furthermore, the use of proper cryptographic
standard can prevent the data being accessed by any third
party. Since majority of the IOT devices in healthcare is
controlled with the help of smart phone applications, it is
necessary to provide antivirus protection as well [33].
The emergence of IoT in healthcare has recently experienced
a burst of activity and creativity and therefore it is expected
that the security issues will be rightly acknowledged.
3.2. Security Requirements of IoT in healthcare/Solutions to
the security threats
With the increase in the use of IoT devices in healthcare, it is
essential for the IoT based healthcare solutions to consider the
different security requirements associated with the use of IoT
devices. The different security requirements of the use of the
IoT devices are as follows-
Confidentiality: Maintenance of the confidentiality of the data
ensures that the medical information stored in IoT devices or
associated with the use of the IoT devices remains
inaccessible to the unauthorized users. Maintenance of the
confidentiality helps in preventing the information availability
to the eavesdroppers
Integrity: The integrity feature of the IoT helps in ensuring
that the received medical data is not altered in its transit. This
is essential as the integrity of the stored data in IoT devices
should not be compromised.
Authentication: The data authentication in IoT is essential as
it helps in ensuring the identity of the peer with whom the
device is communicating [23][32].
Availability: one of the major security requirements in IoT
device is data availability. Since any security issue associated
with the use of IoT can risk the life of the patients, it is
essential to ensure the healthcare services are available to the
authorized parties when needed even in cases of denial of
service attacks.
Data Freshness: It is another main security requirements
associated with the use of the IoT devices in healthcare. This
is one of the significant need as each IoT healthcare network
provides certain time varying measurements and therefore, it
is needed to ensure that the data is fresh. Furthermore, the
freshness of the data implies that each data set is recent and
there is no adversary replay of the old messages [32].
Non-Repudiation: The security feature of non repudiation
ensures that a node cannot delay the sending of a message.
Authorization: Authorization is another key requirement of
security in IoT. This is because it ensures that only the
authorized individuals are allowed to access the network.
Resiliency: There are major security risks associated with the
use of the interconnected healthcare device. This is because if
the interconnected health devices are compromised, a security
scheme should protect the device or the network from any
attack. Attack prevention is necessary as it any attack in the
IoT network can risk the life of the patients.
Fault Tolerance: A security scheme that is protecting the IoT
device should continue to provide the respective security
services even in presence of a fault. With the improvement of
the IoT devices and improve in the technological
improvement, it is essential for the IoT device to posses the
capability of fault tolerance.
Self-healing: the medical device, which is an IOT device,
might fail or run out of energy and therefore, the self healing
is essential. In case an IoT device fails to perform, the
remaining of the collaborating device should enable a
minimum level of security.
3.3. Security Challenges and limitataions in IoT
Since the security requirements of the IoT devices are not
ensred by the traditional security techniques, proper
countermeasures are needed in order to address the challenges
posed by the IoT devices.
The computational limitations are quite widespread as the IoT
healthcare devices are mainly embedded with a low-speed
processor [36]. There is certain memory limitation associated
with the use of the IoT devices. There are certain energy
limitations associated with the use of IoT devices in
healthcare. These issues can be mitigated by technically
improvising the use of the IoT devices.
4. FUTURE RESEARCH
One of the significant benefits of using IoT is healthcare is its
ability to use the sensors in monitoring and maintenance of the
medical devices [37]. However, there are certain challenges
associated with the use of IoT devices in healthcare, which are
identified in the previous section. The use of IoT in healthcare
is far more than a gimmick as the inventory management is

changing the way hospitals operate. However, there are
certain opportunities that can be used to innovate the IoT in
healthcare. This is because the healthcare is one of the richest
areas of opportunity for IoT. This is because the use of IoT
devices in healthcare can considerably reduce the cost of
medical treatment by replacing or providing a lower cost
alternative to the traditionally expensive devices [34]. The use
of IoT in healthcare can further help in interconnecting all the
devices of the network in order to improve the accessibility
and capturing of the data with greater accuracy. Various
researches are performed in the field of internet of things and
healthcare in order to improve its adoption and use in the
healthcare industry. Further research can be done in this field
in order to identify whether the security risks that are
associated with the use of the IoT devices can be eliminated or
not.
5. ADVANTAGES/ DISADVANTAGES
There are certain advantages and disadvantages associated
with the use of IoT devices in healthcare. The advanatages
and the disadvantages of using IoT devices in healthcare is
represented in the following table [15]-
Advantages Disadvantages
The use of IoT in healthcare
reduces errors in collection of
data as it allows accurate data
collection and automates the
workflows. Therefore it
reduces the risk of error.
One of the major concerns
associated with the use of IoT
in healthcare is privacy of the
patients’ data.
With the use of IoT, the
monitoring of the patient can
be done in real time that
drastically cuts the need of
the doctor in making a visit to
the patients.
The use of IoT device is
associated with certain
security breaches along with
denial of service attacks.
The use of IoT helps in
improved disease
management. With the
collection of real time data, it
is possible to spot any disease
before it spreads and
becomes a serious issue.
Device management and the
activity monitoring becomes
a tough task
The use of IoT further helps
in improving the patient
engagement by allowing
them to access their own
health data with the help of a
smart phone application.
Hospitals often finds it
difficult to manage a series of
IoT devices
The use of IoT further helps
in generating a meaningful
and timely health alert that
helps in saving the lives of
critical patients.
There are certain cyber
security risks associated with
the use of the IoT devices.
Table 1: Representing the advantages and the
disadvantages of use of IoT in healthcare
6. CONCLUSION
Therefore, from the discussion and research about the use of
IoT in healthcare, certain conclusions can be drawn.
Researches associated with the use of IoT in healthcare have
started to explore across the world. This research paper takes
into consideration the different aspects of the IoT based
technologies and its use in healthcare. The paper provides
detailed research activities that have been performed in the
field. The literature review chapter gives an idea of the past
research works and further helps in analysing the use of IoT in
healthcare. The paper taken into consideration several
important issues associated with the use of the IoT in
healthcare. Internet of Things is a broad concept that reflects a
picture of interconnected device that are put to use. The use of
the IoT devices in healthcare has a number of benefits. There
are a number of applications of IoT in healthcare and there are
a number of benefits of using IoT in healthcare. Since the use
of IoT in healthcare can considerably reduce the medical
costs, several researches are done in this field in order to
increase the use and adoption of IoT in healthcare. The
research paper discusses the several challenges associated
with the use of IoT in healthcare. The risk mitigation
approaches for the risks are further discussed in this paper.
The research paper further gives an overview of the
advantages and the disadvantages of using IoT in healthcare.
Further researches are to be done in this field in order to
increase the secure use of IoT in healthcare. Maintaining the
security of the IoT devices is essential as it might risk the lives
of the patients. The various security issues and the security
requirements associated with the use of IoT devices in
healthcare is discussed in this research paper. With the
increase in adoption and the sophistication in the use of the
IoT devices, there is an increase in the number of attacks in
the IoT devices. Therefore maintenance of proper security of
the IoT devices are very essential. An extensive literature
search has been performed in developing this research paper
and in understanding the use of IoT in healthcare. The use of
IoT in healthcare can be a great advantage to the patients in
remote location nd for the doctors as well. This is the main
reason why there is an increase in the use of IoT devices in
healthcare.
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