Securing internet of medical things systems: Limitations, issues and recommendations

Abstract Traditional health-care systems suffer from new challenges associated with the constant increase in the number of patients. In order to address this issue, and to increase the accuracy, reliability, efficiency, and effectiveness of the health-care domain, the Internet of Medical Things (IoMT) was proposed. IoMT can be considered as an enhancement and investment to respond more effectively and efficiently to patients’ needs. However, IoMT suffers from different issues and challenges such as the lack of security and privacy measures, in addition to the necessary training and awareness. In this paper, we highlight the importance of implementing the right security measures and the required training skills, in order to enhance the immunity of IoMT against cyber-attacks. Moreover, we review the main IoMT security and privacy issues, and the existing security solutions. These solutions are classified as cryptographic or non-cryptographic. Then, the different solutions are analyzed and compared in terms of computational complexity and required resources. It is important to note that the security measures for IoMT exhibit a trade-off between the security level and the system performance, especially in the rise of digital healthcare v4.0 era. Next, we discuss the appropriate security solutions such as lightweight cryptographic algorithms, and protocols that attempt to reduce the overhead in terms of computations and resources. This leads to the conclusion that there is a need to design an efficient intrusion detection/prevention system that cooperates with dynamic shadow honeypots. Finally, we propose a security solution, which is divided into five different layers to detect and prevent attacks, in addition to reducing/correcting the damage of these known attacks and preserving the patients’ privacy. However, it should be noted that zero-day attacks and exploits are still the main challenging issue that surrounds IoMT.