Problem Statement

Discuss about the Security Challenges in IOT Health Care.

The increasing growth of the wireless communication increases threats and challenges with respect to security. In the last five years, the capabilities and working platform of Internet of things is combined with the health care. The implication of the IOT in health care sectors helps in resolving the issues which exist with the traditional working of the health care. The cyber –attacks is the most prominent security issues and challenges which exist with the health care industries. The new revolution has been built with the implementation of IOT in the medical services [4].  The IOT focuses on the development of smart medical devices to provide cost effective medical treatment to the required patient. The use of IOT and RFID reader helps in keep monitoring of medical assets and services provided to the patients. The digital platform of IOT helps in providing quality of services to the patient with regards to smart pills, personal health care robotic system, and smart home care. The association of the internet services and IOT platforms increases the security challenges and threats in the field of medical sector [5]. The inclusion of IoT services helps in the development of effective real time monitoring system, peer-to peer connectivity to the patient, assortment of data, and developing the alert and tracking system. The accelerated growth has been predicted in the development of IOT application developed for the welfare of the medical services [3]. The special attention should be given to the security threats and challenges due to the cyber-attack. In this paper, we are looking forward to research on the security issues which exist with the IOT health care industry.  

The traditional working of the health care centre is comprised of various problems such as improper management of patient health records, fetching and retrieving of the health records from the paper documentation is the problematic scenario, time consuming process, lack of availability of expert doctors, long queues for taking appointments with doctor, and others. The deployment of the IoT in healthcare is capable of resolving all the complexities of the traditional working environment of the hospitals. The increasing growth of internet services in the development of the health care and medical sector raises the concern of security and confidentiality associated with the leakages of personal records, health report, and others [6]. The decision making capabilities of the doctors and experts depends on the accuracy of the information about the patient health record. The manipulation and modification on the patient health records will result in inaccuracy in providing effective treatment to the patient in critical condition. It can increases the patient life risks. The security related to the data leakages and the gaps in the IoT protection measures should be analysed for developing an effective security architecture framework.

Aim

The aim of the project is to research the challenges and threats which exist in the field of medical services with the involvement of IOT platform. We will also focuses on the countermeasures to resolve the challenges and threats which are discovered during the research program on the IOT health care.

The objective of the research program is to find out major security issues which comply with the IOT health care. The different methodologies will be used for analysing the IOT heath care with different perspective view. The literature review is organized for collecting relevant data to study the security concern in the field of health care sector. The focus should also be given on the countermeasures and benefits in relation to the IOT health care system.

• What are the security challenges in the IoT health care?
• Which is the biggest threat to the IoT environment?
• What are the mitigation plans and countermeasures to resolve the problematic scenario of IoT health care?
• What is the future scope of the undertaken research agenda?
• What are the advantages and disadvantages of the IoT health care environment?

The health is the major concern of every individual. The development of smart health care by making use of Internet of things helps in providing good quality medical services at the home of the patient. The researchers are going in the field of health care to provide effective services to the patient. The security is the major concern for the growing demand of IoT in preserving confidentiality of the patient health record. The accuracy of the patient records helps in providing effective treatment to the patient in emergency situation. The patient stores their records, prescriptions, check-up reports, and others on the Hadoop file structure which is created for managing the big data of the health care centre [7]. The availability of the online health records opens the door for the attackers to attack on the cloud premises for retrieving health records data of the patients. The modification and manipulation in the health records of the patients will result in the providing ineffective treatment to the patient due to the availability of wrong data to the experts. It can create a problematic scenario for the patient and the experts. The major challenges in the IOT health care system are categorised as virus and malware attack, man in the middle attack, denial of service attack, interoperability among the IoT devices, and others. 

The IoT health care works on improving the health condition of the patient effectively by analysing the daily activity schedule of the patient. The daily reports of heart beat , breathing system, blood pressure, sugar level, and others, are generated on the system to be provided to the expert doctors to provide treatment to the patient [2]. The priority is associated with the patient in emergency. It is a multi-user technology which means that the data and information of the user can be fetched by many doctors at a time to provide effective treatment to the patient. The complex condition of the patient can be solved by taking suggestions from the experienced and international doctors to give instant treatment for saving the life of the patient [8]. The efficiency and the effectiveness of the IoT in health care depend on the assemblage of equipment in the home care centre of the patient. The integration of various units such as video sensor, equipment for heart beat reading, blood pressure, glucose level and others is the complex task to connect the patient with the IoT health car architecture to provide treatment in their home. The inclusion of the effective centralised system is the key requirement of the EHR system. The uncertainties with the patient life get associated if he is not able to connect with the central database of the IoT system at right time. The improper arrangement of IoT devices can increases the life risks of the patient. The patient should provide complete report of his previous check-ups to get effective treatment from the expert doctors. The tampering of the IoT devices can occur during the transmission of data over the network. The cyber-security of the system should be monitored regularly for omitting the data leakages for the manipulation and modification of the patient health records. The visibility of the data should be increased by maintaining the confidentiality, integrity, reliability, accuracy, and availability of the information. The inclusion of new and advanced technology in the IoT architecture for the health care can create a challenge in the management of the data [1]. The excessive hardware is required to be placed in the home care centre of the patients. The integration of the IoT devices on the network can create a problem of maintainability. The working of equipment can affect the health record of the patients. The elimination of the manipulation and modification in the patient health record is the top priority of security system designed for the IoT health care application [9].  The proper and effective strategy should be planned for coping up with the challenges in the field of IoT health care to provide proper and efficient system which is capable of solving all the request and problems of the patient effectively [10]. The authorisation and authentication of the information helps in maintaining the confidentiality of the information. The vulnerability attacks on the network architecture of the IoT system can harm the following layers of the architecture designed for health care system:

• Low level malicious attack: The attack on the physical layer is difficult to leak the security system developed by using the firewall protection.
• Middle Level Malicious attack: The attackers generally attack on the middle layer to fetch the data during the transmission of the network packets between the patient and the experts.
• High Level Malicious attack: The attack on the network layer can results into the modification and manipulation of the information.  It can damage the integrity and accuracy of the information due to the manipulation operation
• Extremely high level Malicious Attack: The unauthorised accessing of the patient health record system for modification and manipulation of data comes under the extremely high attack. It can violate the accuracy of the information, increases network congestion, and bombarding of network packets, and others.

Objective

The security mitigation plan should be taken into consideration to face the problematic scenario of attacks and breaches in the IoT health care. The mitigation plan should be prepared by making use of cryptographic procedures to minimize the effect of attacks on the IoT health care premises and increasing the efficiency of the proposed system. The security procedures should be laid down for preserving the confidentiality of the information of the patient health record to get effective treatment by providing accurate information to the expert doctors for prescription [11]. The accuracy is the key factor for the IoT health care. The disruption and modification of the information can raises the life risks of the patient. The monitoring and reviewing of security procedures should be carried out periodically for updating and elimination the point of data leakages [12]. Some of the preferred solution to minimize the effect of potential vulnerabilities on the IoT health care:

• Management of security for IoT devices: The integration of the IOT devices helps in getting acceleration of information for the effective management of information between various units of the organization. The privilege should be given on the operating system for managing the IoT devices on the internet. The validation and the verification of the internet connection should be done by making use of security policy framework. The inclusion of intermediate interfaces should be omitted in the development of IoT devices interconnection.
• Management of Security in the network Connection: The encryption and decryption policies should be used for managing the devices on the internet for the formulation of the hardware architecture. Man in the middle attack is the major vulnerability which is associated with the network congestion arises with the big data on the network during the transmission of the packets between the patient and expert doctors. The encryption policies should be used for converting the text messages into the cipher text for managing the secure transmission of information between various units of the IoT environment.
• Verification and validation of the functional security procedures: The high level testing procedures should be incorporated with the system for providing sophistication authorization and authentication mechanism for fetching the information from the patient records. The penetration testing procedures should be performed for measuring the efficiency of software as a service cloud model for managing the big data of the IoT health care system. The fundamentals of the penetration testing are used for reducing the effect of Advanced persistent threats developed for the IoT health care architecture. It helps in managing secured transmission of the information.
• Mitigation procedures for attack on the side channel: The processing of the data should be performed on the side channel of the IoT architecture. The security testing should be performed for preventing the attack on the premise of the IoT healthcare units.
• Reviews of the security code: The reviews of the security code should be generated for every phase of the IoT architecture should be performed. The encryption procedures should be equipped in the booting process of the system.
• Performing Penetration testing on peer to peer phases: The vulnerabilities should be checked for every phase of the IoT architecture to perform the penetration testing procedures. The proof reading should be performed for developing the secured environment for the IoT health care architecture.

The secured architecture of the IoT environment is comprised of various components such as sensors, services, gateways, mobile interface, and the web interface. The penetration testing is performed for removing the security issues such as tampering, spoofing, information disclosure, repudiation of the information, denial of service attacks, and others [13]. The security parameters should be designed for managing the security related to the IoT devices and assets, cryptographic approach for managing tampering defects, development of the secure routing structural plan, making use of effective low power cryptographic procedures for preserving the complexities, and others. The future of the IoT health care centre is very bright. The research should be designed for increasing the reachability of the patient to the IoT health care with the inclusion of minimum cost required to get effective treatment. The remote monitoring of the patient by the expert doctors increases the reachability to the patients who geographically distant apart from the patient. The patients are provided effective treatment in the comfort of their home. It also helps the family members to take effective care of the patients. The video sensors and the CCTV cameras helps in increasing the analysis of the daily routine activities performed by the patients which helps in measuring the signs of improvements. The implementation of the mitigation procedures helps in developing effective and efficient system for IoT health car to provide quality of service to the patient in their home care centre. The mitigation procedures such as development of secure socket layer and encryption policies to eliminate the risks and the threats associated with the IoT health care system. 

Research Questions

The traditional working of the medical industry was facing problem in handling the big data of the patient systematically. In the emergency situation the chance of patient life risks is increasing to reach to the hospitals. The realization of these problems gives rise to the development of IoT health care system. It helps in maintaining the electronic health records of the patient which can be retrieved by multiple doctors at a time to study the patient case. The major problem with the IoT system is the security of the personal data uploaded by the patient. The effective working of the health care system depends on the maintenance of accuracy with the premises of the IoT devices and assets. The patient can get effective treatment in his home care by the active participation of the medical officers and experts from Global level. The complex and critical condition can effectively solved by taking suggestions from the different experts sitting at global level through the common platform of IoT health care. The implementation of IoT health care faces some challenges and issues in carrying out the task of effective management of health services. Some of the issues which exist with the IoT health care are listed below:

Issues	Description
Technical Risks	The availability of required hardware and software at the home care centre of the patient to reviewed critical condition of the patient while sitting geographically apart from the patient. It requires the implementation of video cameras, sensors, heart beat reader, blood pressure machine, glucose level machine, and others
Operational Risks	The family members and house-keeping staff should be trained enough to handle the operational working of the patient care on the advice of the expert doctor from the Internet
Financial Risks	The increasing cost of the project to settle down the home care centre in the patient home is the major problem.
Legal Risks	Risks of patient life can raises the legal risks on the participating doctors and staff members. The agreement should be signed before operating through the IoT health care. The proof reading of the documentation presented to the doctors should be done before the implementation of the expert decision
Availability of house-keeping staff risks	The availability of the expert house-keeping staff who can successfully follow the advice of the doctor to provide effective treatment in the critical situation of the patient
Network Connection Risks	The high speed network connection is required for managing the flow of information between various units for proper communication without any hindrance

The development of the effective and efficient IoT health care system is cope up with various challenges which can raises the concern of security issues in the proposed system. The advancement in the IoT health care is associated with advanced security issues which can adversely affect the functioning of the system. The big data management system is the emerging requirement of the health care because the increasing number of customers who are getting associated with IoT health care result in excessive burden of storing big data generated from the patient health records, check-up reports, and previous prescription of the doctors. It is the major challenge to store the data of the patient systematically on the network. The big data management can be effectively done with the use of Hadoop file structure because it works on the Map reduce principles which can minimize the data to store it conveniently in the database. The requirement generated by the doctor about the patient records, he is provided with the systematic arrangement of the patient record. The security procedures should be laid down for preserving the confidentiality, accuracy, reliability, integrity, and availability of the information. The manipulation and modification of the patient health record should not be done without the permission of the patient. The expert should be provided with accurate information so that they can give effective treatment according to the requirement of the patient condition. The control policies and security architecture should be developed for preserving the accuracy of the patient health information. The monitoring of the security system helps in minimizing the security challenges which are associated with the IoT health care. Some of the major challenges which are associated with the IoT health care are listed below:

Security Challenges in the health care	Description
Maintaining privacy of data	The video sensor placed in the home care of the patient will reveals the daily routine activities which are performed by the individual. The privacy of the individual get disclosed due to the analysis of the daily routine activities performed by the patient in their home care. It is difficult in finding alternating solution to the video sensor to preserve the privacy of the patient.
Development of the security system	During the transmission of the data transfer between the patient and the expert the chance of data leakages can occur. The attacker hack the data through the analysis of the observation pattern of the process. The data hiding procedures should be used for preserving the observation of the data which is transmitted over the network for communication to get effective health care prescription from the doctor [14].
Insurance policies	The heal14th risks can be analysed by the insurance companies who can deny to give effective health and medical policy to the patient [15].
Managing big data of the health care records of the patient	The limited space of the database is not able to store the big data of the health care industries in the systematic manner. Therefore, the need of Hadoop file structure for managing big data of the patient by using the concept of Map-reduce technology
Confidentiality of the patient health record information	The patient stores their check-up reports, prescription, tele-medicine, and other details on the internet. It is required to use the security procedures for preserving the confidentiality of the information from manipulation and modification of the data.
Viruses and Malware attacks	The IoT system should be preserved from the attack of viruses and malware because it can damage and manipulate the information of the patient health records and latest prescription of the doctor to get effective treatment
Accuracy of the Patient health record	The manipulation and modification in the patient health record system can increases the life risks of the patient
Integration with the IoT devices	The efficiency and the effectiveness of the IoT system in health care industry depends on the management of devices used for recording the health condition of the patient.
Interoperability between various IoT devices	The transparency and visibility in the information presented by the different units placed in the home care centre of the patient is the problematic situation
Complete reports of the patient	The patient can get effective treatment from the expert doctor if he presented his previous medical reports and check-up reports only in the systematic manner
Inclusion of new advanced hardware and software technology	The complexity in maintaining the IoT health care with the transformation of new technology
Man in the middle attack	The manipulation and modification in the eaves dropper of the IoT system can disrupt the accuracy of the information (Sayana, and Joshi, 2016)
Routing of the health data	The change in the routes due to the heavy traffic and congestion on the network can create the problem of hacking
Fabrication	The information can be modified by providing false authorisation to the third party in the records of the patient
Denial of service attacks	The bombarding of the network packets can create the network congestion which disrupt the normal functioning of the proposed architecture.
Blocking of the information	Some viruses can block the information of the patient to the expert doctor to get effective treatment on time  such as Trojan Horse.
Imitation process	The unauthorised accessing of the patient record system by fetching the login credentials of the user by unfair means. It can results into hacking of data, loss of confidentiality, loss of accuracy, and loss of reliability to be used for prescription
Limitation in the encryption procedures in the transport layer	The communication is not completely done in the encrypted architecture on the IoT healthcare system
Insecurity in the Interface	Various attacks like scripting and forgery attack on the cross side platform
Authorization and Authentication	The operating of the user account with the illegal means of hacking password and user ID of the patient

Literature Review

The mitigation policies and preferred solution should be prepared for coping up with the security challenges faced in the laying down of IoT healthcare architecture. The monitoring and control policies should be prepared for designing of the IoT architecture so as to reduce the complexities and challenges which are occurred in the efficient working of the IoT solution. The proper consideration should be given to the security policies. The cryptographic procedures and encryption methodologies should be used for preserving the online data of the patient [16]. The firewall protection should be given to the premises of the IoT health care for managing and coping with the problem of data leakages which is the major issues for modification and manipulation in the information of the customers. The privilege should be given to the priority associated with the challenges in securing the premises and the database of the patient from the third party attack.

Components	Attacks	Mitigation
Management of the Gateways	Attacks on the communication platform such as interception and tampering.	Security procedures should be equipped with the help of secured socket layer
IoT health care services	Denial of service attacks, spoofing of the identifiers on the database	Development of secure socket layer, Implementation of monitoring plan for network traffic management, management of the network congestion
Management of the web interface	SQL injection in the database	Parameterised checking of the query statement Sanitization of the input used for SQL statement
Communication between web application and the third party	Attacks on the communication platform such as interception and tampering.	Security procedures should be equipped with the help of secured socket layer
Inclusion of the data sources	Privacy issues	Collection of associated data Development of the Hadoop file structure for managing big data
IoT Devices	Virus and malware attacks	Deployment of antivirus and antimalware for preserving the functionality of the IoT devices in carrying out secure transmission of data.

Advantages of IoT in Health care

It is advantageous for using the IoT in health care organization because it is capable of providing effective treatment to the individual patient from multi-user expert who are geographically dispersed. The expert can have a live discussion on the critical situation of the patient to provide instant treatment to resolve the complexity of the life risks. The traditional working of the hospitals is very complex because it is very difficult to retrieve the information of the patient from the paper documentation. The life risks of the patients increases in the emergency situation due to the non-availability of the doctor, operation theatre, first aid system, and others [17]. The IoT is the best solution for resolving all the complexities of the traditional health care organization effectively. The monitoring of the patient health through the remote system helps in increasing the instant reachability of the doctors in instant situation. The IoT is beneficial in managing the control over the patient life risks effectively. Some of the major benefits of using the IoT in healthcare are given below:

Higher efficiency and engagement to the patient: The remote monitoring system of the IOT health care helps in providing effective treatment to cope up with the critical situation of the patient. The effective first aid provided to the patient in home care helps in improving the patient life. The patient should upload his records on the database of the IoT system. The progress of the system depends on the accuracy of the information provided by the patient to the doctors. The experts can refer to the previous reports of the patient to give instant prescription.

Better result: The outcome of the IOT health care can be measured on the basis of preserving the life of the patient. The patients are provided with the real time treatment in the home care of their houses. The IoT health care works on improving the health condition of the patient effectively by analysing the daily activity schedule of the patient. The patients are monitored by multiple experts at a time to give effective treatment. It can be seen that the life of the patient can be secured by managing the treatment in the home care. It avoids the time consumed in taking appointments in the emergency situation of the patient. 

Accuracy in the health treatment: The accuracy in providing effective treatment to the patient is the core advantage of using the IOT in health care. The effective treatment can be provided to the patient for improving the critical condition by getting advice from the multiple medical experts. The patients provide their previous health records to the expert doctor to analyse the case and helpful in giving appropriate advice according to the situation analysis. The recommendations from the expert doctors from the global location can be taken on the complex situation of the patients.

Comfort to patient: The patients are getting treatment in their home environment which increases their feasibility in getting things done. The patients feel comfortable in getting treatment in their home care centre.

Use of cloud environment: The cloud computing environment increases the feasibility of getting approach to the information provided by the patients because the Hadoop file system helps in arranging the data in the sequential manner [18].

Tracking of patient condition: The monitoring of the patient can be effectively done with the use of IOT devices such as video sensor, video cameras, device for glucose sugar level requirement, and others. The alert messages are generated on the system and mobile devices of the medical experts who are connected with the IOT environment about the patient who are in critical stages [19].

Remote monitoring system: It is a time effective technology. The patient who is in critical stage requires treatment in emergency. In the traditional working, lots of time is get wasted in selecting hospital, reachability to the hospital, checking availability of the expert doctors, availability of operation theatre, and others. The IOT is the preferred solution to resolve these complexities because it is providing real time monitoring of the patient health in the home care centre through the IoT devices. It does not require to take appointment, checking availability of the doctors, and others. The instant medical treatment can be provided to the patients in the home care centre [20].

Communication: The IoT environment is based on machine to machine communication which is efficient for sending relevant information on the patient and doctor working environment.

Big data management: The cloud computing environment increases the feasibility of getting approach to the information provided by the patients because the Hadoop file system helps in arranging the data in the sequential manner.

Disadvantages of IOT in health care

The deployment of the IoT in health care environment is cope up with numerous disadvantages too. The major problem with the IoT system is the security of the personal data uploaded by the patient. The effective working of the health care system depends on the maintenance of accuracy with the premises of the IoT devices and assets. The management of the big data generated is the basic necessity of the IoT health care because of the increasing number of patients associated with the IoT environment can increase the risks of inefficiency in managing systematic retrieval and information flow between various units of the healthcare environment. Some of the disadvantages associated with the IoT health care centre are highlighted below:

Security: The security is the major concern in the IoT environment because the third party or hackers can retrieve the information of the patient personal information during the transmission of information between patients and doctors. The loss of confidentiality can results in threats to the personal data of the patients which is stored on the IoT health care cloud environment.

Cost: The installation of the heavy machines for the check-up of the patients heartbeat, glucose level, video sensors, CCTV cameras, and other can increases the cost of the medical treatment provided to the patients. 

Complexity: The network management of the IoT devices is the complex tasks because it is a set-up of various IoT devices which are used for checking the health condition of the patients.

Privacy: The deployment of the video cameras and sensors will result in keeping records of daily activities program carried out by the patient in their home care. The information of the daily activities program is stored on the public cloud for retrieving the information according to the demand of the experts.

Accuracy: The IoT health care environment works on the fundamentals of accuracy program. The security procedures should be laid down for preserving the loss of data from data leakages because the manipulation and modification in the health records of the patients can increase the life risks of the patients because the experts are provided with the false reports on the basis of which patients get prescriptions [21].

Internet Connection: The IoT system is based on the internet. The high speed broad band connection is required for managing the flow of information between the participating units. The failure of the internet connection can increases the life risks of the patients due to the incompatibility with the network connection to provide effective treatment from the expert doctors.

Future Research:

The research was conducted on the security issues which exist with the IoT health care. It has been found that the use of IoT in health care has a positive and negative aspect of working in providing health treatment to the patients. The challenges related to the security, integrity, and accuracy of the information in the IoT environment is the major concern area for developing effective and efficient system. The security challenges in the IoT environment opens new door of research for developing effective and efficient security framework which can be applied to resolve the complexities of the IoT system in the real life scenario [22]. The development of the security framework should be highly efficient in managing the intelligent working of the system. The effective communication standards should be developed for managing secured transmission of data between the participating units. The machine learning capabilities of the IoT environment should be enhanced so that in-time treatment can be provided to the patients who are in critical stages which helps in providing quality of services provided to the patients. The encryption schemes for the light weight processes should be developed for preserving the confidentiality of data transmission in the real time scenario. The smart phone application should be developed for replacing the arrangement of heavy IoT devices such as Heart beat measuring machine, glucose level machine, blood pressure level, and others which in turn helps in reducing the cost of using IoT environment for providing treatment to the patients. The mitigation procedures should be used for preserving the confidentiality, integrity, accuracy, and reliability of the information. The future of the IoT health care centre is very bright. The research should be designed for increasing the reachability of the patient to the IoT health care with the inclusion of minimum cost required to get effective treatment.

Conclusion

The research is conducted on measuring the security challenges associated with the IoT health care for providing effective and instant treatment to the patient in critical stages. The traditional working of the hospitals can effectively resolve with the deployment of IoT in health care organizations. The expert can have a live discussion on the critical situation of the patient to provide instant treatment to resolve the complexity of the life risks. The outcome of the IOT health care can be measured on the basis of preserving the life of the patient. The patients are provided with the real time treatment in the home care of their houses. The patients are monitored by multiple experts at a time to give effective treatment. The advancement in the IoT health care is associated with advanced security issues which can adversely affect the functioning of the system. The big data management system is the emerging requirement of the health care because the increasing number of customers who are getting associated with IoT health care result in excessive burden of storing big data generated from the patient health records, check-up reports, and previous prescription of the doctors. It is the major challenge to store the data of the patient systematically on the network. The monitoring and control policies should be prepared for designing of the IoT architecture so as to reduce the complexities and challenges which are occurred in the efficient working of the IoT solution. The proper consideration should be given to the security policies. The cryptographic procedures and encryption methodologies should be used for preserving the online data of the patient. The IoT health care environment works on the fundamentals of accuracy program. The security procedures should be laid down for preserving the loss of data from data leakages because the manipulation and modification in the health records of the patients can increase the life risks of the patients because the experts are provided with the false reports on the basis of which patients get prescriptions. It is advantageous for using the IoT in health care organization because it is capable of providing effective treatment to the individual patient from multi-user expert who are geographically dispersed. 

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