The Internet of Medical Things (IoMT) are medical devices that can communicate over the Internet to transmit patient information. It is the fastest and most optimal way to make hospitals more efficient, provide doctors with the most relevant patient information and speed up medical processes.
Benefits and impact of IoMT on healthcare
IoT in healthcare involves networking physical objects using embedded sensors, actuators and other devices capable of capturing and transmitting real-time information across the network. How? Through this connected infrastructure of medical devices, software applications and healthcare systems and services.
IoMT (Internet of Medical Things) also makes it possible to record and store each patient’s medical history in the cloud, to provide medical care and monitor their case remotely.
Medical device companies manufacture a wide variety of medical devices (estimated at over half a million), such as pacemakers, home monitoring systems, blood glucose monitors and many others. When you consider that all these devices can connect to the Internet and send real-time information to healthcare professionals, it is easy to see how important IoMT is to medicine today.
- Provide real-time information on the patient’s health status.
- Enable personalized patient monitoring and immediate treatment correction.
- More efficient management of available medical resources, leading to a reduction in service costs (hospital bills are reduced).
- Reduce errors in diagnosis and treatment.
- Reducing the time taken to provide medical care (e.g. reducing waiting lists at health centers and hospitals or waiting times for surgery).
- Improve the patient’s experience in the health center, with personalized appointments and better optimization of the care space.
Key IoMT devices, types and applications
Based on the above, a wide variety of IoMT devices are in use and being developed, which fall into a wide range of categories. These include:
– Consumer Wearable Devices.
These include smart wearable devices such as blood pressure and glucose monitors that detect abnormal heart rhythms and provide ECG-like readings. Some record heart rate, detect irregularities and automatically alert the user.
– Medical wearables.
These are regulated, clinical-grade products used under medical supervision. This group includes devices designed for pain management, physical performance enhancement and other health issues.
– Remote patient monitoring (RPM) devices.
These are systems that support chronic disease management and are typically placed in the home of patients undergoing long-term treatment.
– Personal Emergency Response Systems (PERS).
These are portable devices worn by patients, usually older adults, that alert a family member or carer in the event of an emergency. Specialist help can then be sent to the scene of the incident.
– Smart pills.
This is certainly an emerging category of devices that can be swallowed by the patient and wirelessly transmit data about their internal state to treating physicians.
– Point-of-care devices and kiosks.
This category includes mobile devices ranging from ultrasound scanners to blood glucose monitors. They make it possible to obtain diagnostic information and other health data in the doctor’s office or in the field – without the need for a full laboratory.
– In-clinic monitors.
These are similar to point-of-care devices. However, unlike point-of-care devices, they can be managed remotely without the need for a healthcare professional to be on-site.
– In-hospital devices.
Within this segment, we have MRI machines that are used to track hospital assets and control patient flow. They are also used to monitor drug and instrument inventories and manage other resources.
So, how do we know if our patient data is safe?
This technological revolution brings significant challenges in safeguarding information. The vast amounts of personal and health data collected, processed, stored, and transmitted by these devices must be protected under the core principles of information security: Confidentiality, Integrity, and Availability (CIA), through a combination of complex security measures.
Confidentiality
Confidentiality ensures that personal health information is only available to those who are authorized to access it: this includes sensitive data such as medical history, diagnostic information and personally identifiable information (PII).
Data encryption: Encrypting data both in transit and at rest is critical. This ensures that even if an attacker intercepts the information, it cannot be read without the decryption key. Protocols such as Transport Layer Security (TLS) and Advanced Encryption Standard (AES) are essential to ensure the confidentiality of IoMT data.
Robust authentication: Multi-factor authentication (MFA) mechanisms provide additional layers of security. The combination of passwords, biometrics and physical tokens significantly reduces the risk of unauthorized access.
Role-based access control (RBAC): Implementing RBAC ensures that only users with specific permissions can access several types of data. In a hospital environment, this could mean that only relevant medical staff have access to complete patient histories.
Integrity
Integrity refers to ensuring that information is accurate and unaltered except by those authorised to change it. In IoMT, maintaining data integrity is critical because any alteration could have life-threatening consequences for patients.
Digital signatures: The use of digital signatures on data generated by IoMT devices ensures that any unauthorized changes can be detected. These signatures verify the authenticity and integrity of the data.
Real-time integrity monitoring: Implementing continuous monitoring systems that detect any unauthorized changes to data is essential. This can include hash verification or the use of blockchain technologies to immutably record data transactions.
Input validation: Ensuring that all data entered systems, whether automatically generated by IoMT devices or manually entered by users, is validated to prevent the introduction of malicious data that could compromise integrity.
Availability
Availability ensures that data and resources are available to authorized users when they need them. For IoMT devices, availability is critical because any interruption in device functionality could put patient lives at risk.
System Redundancy: Implementing high availability (HA) architectures and geographically dispersed backups ensures that systems remain operational in the event of hardware failure or natural disaster.
DDoS mitigation: Distributed Denial of Service (DDoS) attacks can take critical IoMT devices offline. Using web application firewalls (WAF) and cloud-based DDoS mitigation solutions helps to ensure that essential services remain operational.
Regular patching and updates: Timely software updates and security patches are critical to maintaining availability. IoMT devices often run outdated firmware, making them vulnerable to attack. An efficient update management process is essential for security.
Key concept of IoMT
Device Security
Ensuring that individual IoMT devices are protected from unauthorized access and manipulation is fundamental. This includes:
Secure Boot: Implementing secure boot processes ensures that only legitimate, approved firmware is running on devices. Any attempt to modify the firmware during boot should result in the device being locked down.
Secure firmware updates:Firmware updates should be digitally signed to ensure their authenticity, preventing attackers from injecting malware through fake updates.
Robust authentication mechanisms: In addition to passwords, devices should use two-factor authentication or biometrics to ensure that only authorized users can access the device.
Network security
Protecting the communication channels between IoMT devices and networks is essential to prevent eavesdropping and unauthorized access:
Communications encryption: Secure protocols such as SSL/TLS should be used to encrypt communications between devices and servers to ensure that intercepted data cannot be read by attackers.
Secure protocols: Implementing secure network protocols, such as MQTT with TLS encryption, ensures that communications are protected from man-in-the-middle and other eavesdropping attacks.
Data security
Protecting the data generated, transmitted and stored by IoMT devices includes:
Data encryption:As mentioned above, data needs to be encrypted both in transit and at rest. Tools such as BitLocker for disk encryption and TLS for communications encryption are essential.
Secure storage solutions: Data stored on servers or in the cloud should use secure storage solutions that include data encryption and role-based access controls.
Data integrity verification: Implementing data integrity verification mechanisms, such as checksums or cryptographic hashes, is essential to ensure that data has not been tampered with.
Identity and Access Management (IAM)
Effective identity and access management is critical to IoMT security:
Robust IAM: Implementing an IAM system that manages the identities of users, devices and applications is essential. This includes using directory services such as Active Directory and enforcing role-based access policies.
Multi-factor authentication (MFA): Integrating MFA for access to IoMT devices and associated systems ensures that only authorized users can access critical information.
Endpoint Security
Endpoints, such as sensors and actuators, must be protected from both physical and cyber threats:
Secure design: The use of tamper-resistant hardware, such as Trusted Platform Module (TPM) chips, ensures that devices cannot be physically compromised without detection.
Physical threat protection: Implementing mechanisms to protect against physical tampering, such as security seals and physical access detection, is critical.
Common IoMT Threats and Mitigation Strategies. Cybersecurity Concerns for IoMT Devices.
As healthcare systems become increasingly reliant on connected medical devices, the frequency and sophistication of cyberattacks targeting the Internet of Medical Things (IoMT) has skyrocketed. A stark example is the ransomware attack on the Hospital Clínic de Barcelona in 2023, which severely disrupted patient care and compromised sensitive data. This incident highlights a wider trend: cybercriminals are increasingly targeting healthcare institutions; due to the critical nature of the services they provide and the high value of medical data on the black market.
The motivations behind these attacks range from financial gain – through extortion tactics such as ransomware – to ideological goals or even state-sponsored espionage. The stakes are high; a successful breach can not only result in financial loss, but also jeopardize patient safety, making the need for robust IoMT security more urgent than ever.
Side channel attacks exploit information leakage through indirect means, such as electromagnetic emissions. IoMT devices can be vulnerable to these attacks if they are not adequately shielded. Mitigation includes the use of masking techniques and physical isolation of the device.
Tag cloning. Attackers can duplicate data obtained in a side-channel attack to gain unauthorized access to information. To protect against tag cloning, use secure RFID tags with authentication and encrypted communications.
Device tampering. Physical access to IoMT devices allows attackers to manipulate their functionality. Protecting these devices requires tamper-resistant hardware, firmware integrity monitoring and physical access detection mechanisms.
Sensor tracking. Devices with GPS sensors, such as patient monitors, are vulnerable to location data interception. Strong encryption and robust authentication of location data transmissions are essential to protect patient privacy.
Eavesdropping. Interception of wireless data is a common threat. To prevent this, all communications must be encrypted, and networks should be continuously monitored for suspicious activity.
Replay attacks. Attackers can reuse previously exchanged authentication messages to gain unauthorized access. Protection against these attacks requires the use of unique tokens or timestamps in authentication messages to prevent reuse.
Man-in-the-middle (MitM) attacks. This attack involves intercepting and modifying communications between two parties. Implementing end-to-end encryption and verifying the authenticity of the communicating parties is essential to prevent MitM attacks.
Denial of Service (DoS). A DoS attack can disrupt the availability of IoMT devices. Solutions include implementing firewalls, using distributed networks and using DDoS mitigation systems.
Are you looking for a partner who understands these challenges?
At D.med Software, we understand the complexities of medical device security throughout the development lifecycle. Our multi-disciplinary team is dedicated to protecting your IoMT innovations from emerging threats, giving you peace of mind while you focus on delivering life-saving technologies. We invite you to explore our comprehensive cybersecurity services and see how we can help secure your medical devices.
Stay tuned to our website and our LinkedIn profile if you have not yet made your decision. There’ll be a series of technical articles where we will dive deeper into specific security controls, providing in-depth guidance on how to fortify your IoMT devices against the latest threats.
Or write to our e-mail and we will solve all your doubts in a personal appointment where we can study your case in depth: info@dmed-software.com
Alessandro “Alex” Vitiello is a highly accomplished software development and engineering professional.
With an Engineering degree from Parthenope University in Naples, Alex has built a strong foundation in technology and leadership. His career began at D.med Consulting in 2015 as Head of Software Development, where he led the creation of a successful software and cybersecurity team, delivering high-quality solutions that adhere to rigorous MedTech standards.
Known for his strategic vision and expertise in healthcare technology, Alex has been instrumental in driving growth and innovation in the industry, consistently demonstrating a commitment to excellence and innovation.