Scenario-based Vulnerability Analysis in IoT-based Patient Monitoring

System

Neila Mekki

, Mohamed Hamdi

, Taouﬁk Aguili

and Tai-Hoon Kim

CommunicationsSystems Laboratory, (SysCom), National Engineering School of Tunis, (ENIT),

University of Tunis El Manar, (UTM), Tunisia

Elgazala Technopark, Higher School of Communication of Tunis, Sup’Com, University of Carthage, Tunisia

School of Information Science, University of Tasmania, Australia

Keywords:

Healthcare, Internet of Things, Scenario, Security Requirements.

Abstract:

The Internet of Things (IoT) is one of the revolutionary technologies for healthcare. However, this ﬂourishing

still faces too many challenges including security and privacy preservation information. To address these

problems, our contribution is to present a scenario of diabetes disease assume a matching between the situation

of the patient and the relevant data from monitoring point view. This scenario describes how a patient can

collect enormous of vital sign and activity. Wireless Body Sensor Networks (WBSN) is one of the IoT building

blocks in which a patient can be monitored using a collection of sensor nodes to improve the patients quality

of life. This technology in healthcare applications should not ignore security requirements. The aim of this

paper is, (1) to design a healthcare architecture for a patient monitoring system, and (2) to explore the major

security requirements in WBSN.

1 INTRODUCTION

Today the number of people with chronic diseases

such as diabetes, cardiovascular diseases, and hy-

pertension is growing exponentially according to the

World Health Organisation (WHO, 2017). This is due

to sedentary lifestyle and different risk factors such as

unhealthy diet, physical inactivity, tobacco, alcohol

consumption, and oxidative stress. It is said (WHO,

2016) that diabetes is considered to be one of a ma-

jor cause of stroke, blindness, heart attacks, kidney

failure, and lower-limb amputation. It will be the 7

leading cause of death by 2030.

However, diabetes can be actively treated and

monitored if an early diagnosis is available. Such

as for many years, the only standard exams consisted

of measuring the glucose level in the health center.

Thanks to technology, it is possible today with a vari-

ety sensor to read vital signs such as heart rate monitor

and blood pressure to take the patient with their vital

sign daily. The main challenge is to detect chronic

diseases early enough to implement efﬁcient mecha-

nism.

Now, according to (Islam et al., 2015) and (Al-

Fuqaha et al., 2015), Internet of Things (IoT) is ex-

pected to be a potential alternative to cope with this

serve. It provides a dynamic environment in which

anything can be able to communicate with other in

anywhere and at any time.

Such as Wireless Body Sensor Networks

(WBSN), (Gope and Hwang, 2016) is one of the most

commonly-used technologies in IoT-based healthcare

systems. It is used to collect a human body function

and also surrounding environment.

However, in transit and stored data in healthcare

application, an attacker for example (Huang et al.,

2017) can be damage health devices or services by

providing a wrong information or remove integrity

data. Therefore, the challenge is to identify and pre-

dict all possible attacks and vulnerabilities associated

to IoT in a healthcare application. To deal with this

challenge our major contribution is organized as fol-

lows:

• To propose a new IoT healthcare monitoring ar-

chitecture, by allowing distributed security strat-

egy.

• To describe the interaction between various ac-

tors and patient monitoring system based IoT, in

which the patient is generated heterogeneous data

based WBSN deployed in this ambient environ-

ment. This methodology is proposed to identify

554

Mekki, N., Hamdi, M., Aguili, T. and Kim, T-H.

Scenario-based Vulnerability Analysis in IoT-based Patient Monitoring System.

DOI: 10.5220/0006473005540559

In Proceedings of the 14th International Joint Conference on e-Business and Telecommunications (ICETE 2017) - Volume 4: SECRYPT, pages 554-559

ISBN: 978-989-758-259-2

the typology of the data collected from the pa-

tients environment based on a scenario-based ap-

proach.

• To evaluate the security requirements according to

time is thoroughly studied. The importance of our

scenario can be used to implement context-aware

techniques in WBSN-based healthcare solutions.

Therefore this paper is organized as follows. Af-

ter the introduction, we give and specify in Section 2

a new healthcare architecture for the patient monitor-

ing system. In Section 3, we present a scenario of a

diabetic patient in which we identify the security re-

quirements. Finally, we provide concluding remarks

and future prospects in Section 4.

2 PROPOSED ARCHITECTURES

From the literature (Al-Fuqaha et al., 2015), (Islam

et al., 2015) we can distinguish that a general archi-

tecture IoT can basically consist of three layers, per-

ception layer, network layer, and application layer.

In this sense, our main contribution in revising

the literature is to present a new healthcare archi-

tecture for IoT, which describes how a patient can

collect enormous of vital sign and activity. We ex-

plain also how doctors can remotely use the patient

monitoring system to the remote. For that, we can

ﬁnd a lot of possibilities to improve the security for

IoT Architectures in health context such as (Valera

et al., 2010), (Hassanalieragh et al., 2015), (Catarin-

ucci et al., 2015), and (Horn et al., 2016). However,

most of the proposed architecture are over to focus

in only one building blocks in WBSN, Gateway, or

cloud. The challenge is to propose a new architecture,

for IoT vulnerability following in each step.

Therefore, our healthcare system architecture as

shown in Figure 1 consists of three building blocks.

• A perception layer: to collect a physiological state

and movement context, by using Wireless Body

Sensor Network (WBSN).

• Network layer: to transmit data to the remote cen-

ter, by using Smart Health Gateway.

• Application layer: to explain a good decision or

to monitoring information. While data mining

(Chun-Wei Tsai and Yang, 2014) and machine

learning (Abu Alsheikh et al., 2014) can be used

to provide smart services IoT, this lies outside the

scope of this paper.

The goal of the research is to design the embedded

security framework for IoT and to model the jamming

attack and design the defensive technique for Wire-

less Sensor Network (WSN)-based IoT. Our contribu-

tion is inspired us to propose a scenario to collect and

monitor the workout routines measurement according

to diabetes disease patient up at 7:00 in a section be-

low.

3 SCENARIO DIABETIC

PATIENT IN IOT HEALTHCARE

In this section, we focus on describing the scenario a

healthcare application IoT, in which a patients health

proﬁle and vital signs are captured sensor attached to

his or her body as shown in Figure 2.

The sensor will also be used to collect somatic

data as the reference to monitor their conditions such

as eating and others risk factors, such as Weight

measuring, Blood glucose (sugar), Electrocardiogram

(ECG), and Heartbeat rate.

It is important at this level to mention that, dia-

betes is a metabolic disease in which patient have a

high blood glucose (sugar) level over prolonged pe-

riod. In a normal subject, the fasting blood glucose

level is about 1g/l.

Moreover, we assume that a person needs to move

from one context to others. Different means of trans-

portation are generally available to include walking,

public transport, and vehicle transport.

Our contribution is twofold. We provide a match-

ing between the situation of the patient (i.e., step in

the scenario) and the relevant data from the monitor-

ing point of view. Second, we associate a set of secu-

rity requirements to each of the data a set too.

The result is very important from the adaptive se-

curity prospection since we provide a set of require-

ments on which dynamic security techniques can be

built to while taking into consideration the variation

of the security requirements.

3.1 Narrative Scenario Remote Diabetic

Patient Monitoring

In this section, we develop a scenario of patient

monitoring medical data to remote healthcare cen-

ter, a ﬁnd to implement the context-aware technique

in WBSN based healthcare solutions. According to,

(Viswanathan et al., 2012), and (Islam et al., 2015) )

less research challenge over context-aware has been

developed. And our challenge is inspired us to ex-

plain a good decision to devise healthcare solution

into three generic level:

Scenario-based Vulnerability Analysis in IoT-based Patient Monitoring System

555

Figure 1: Proposed Adaptive architecture Remote healthcare IoT.

Figure 2: Scenario diabetes disease.

• The context of the patient: at home, moving, cof-

fee visit, main activity, restaurant visit, and shop-

ping.

• The activity monitoring: sleeping, eating, walk-

ing, moving.

• Information capture: blood glucose, weight mea-

suring device, ECG, heartbeat rate measuring de-

vices, time spent of sleeping, walking time mea-

suring device, step counting devices, speed mea-

surement device, calorie spent measuring devices.

A brief description of core scenario is given as fol-

lows:

At Home. WBSN is used to monitor the patient

at home. This scenario includes some other sub-

scenarios such as sleeping, eating (breakfast or din-

ner) or others household activity (effort). For each

sub-scenario, the objective is to monitor the patient.

SECRYPT 2017 - 14th International Conference on Security and Cryptography

556

Moving. The patient can be moving from one con-

text to other by walking, using public transport or his

or her vehicle transport.

Coffee Visit or Restaurant Visit. The patient may

visit a coffee or restaurant.

Shopping the patient visits the market to buy vari-

ous goals.

3.2 Security Requirements Remote

Diabetic Patient Monitoring

The challenge at this terms is to ensure security re-

quirements diabetes disease. A features component,

security requirements based (Islam et al., 2015) are

described as following:

• Conﬁdentiality: has to ensure the inaccessibility

of medical information for unauthorized users.

• Integrity: has to ensure that received medical data

are not altered in transit by an adversary.

• Authentication: has to enable an IoT health device

to verify the identity of the peer with which it is

communicating.

• Availability: has to ensure the availability of IoT

healthcare services to authorized parties when

needed even under denial-of-service attacks.

• Data freshness: has to associate exchanged data

to a speciﬁc session.

• Non-repudiation: has to prove that an action has

been performed by an entity.

• Authorization: has to ensure that only authorized

nodes can access services or resources.

• Data Privacy: has to ensure that only authorized

person that allow speciﬁc a purpose of sharing can

access to information.

• Resiliency: has to guarantee that if a set of entities

are compromised then a security scheme should

still protect the network, device or information

from any attack.

• Fault tolerance: has to guarantee that a security

scheme should continue to provide respective se-

curity services even in the presence of a fault.

In this sense, our objective is to evaluate the security

requirement and to implement resilient security. It can

be divided into two steps: Security requirements de-

pending on information nature, and Security require-

ments depending on the context. In this sub-section

below, we describe as following these two categories.

3.2.1 Security Requirements Depending on

Information Nature

It depends on sensors or activity used to monitor to

interact patient shown in Table 1.

To be more speciﬁc we address two categories:

To Monitor Chronic Disease Management such

as cardiovascular and diabetes. It involves the

lifestyle of the patient via continuous monitoring. The

sensor used in this case include ECG sensor, blood

glucose sensor, heartbeat rate sensor. These sen-

sors should respect some requirements, case to peo-

ple with diabetes will be considered a higher risk

compared to non-diabetics for insurance companies.

Such as they should pay more. It requires pro-

tecting content from eavesdroppers, which aims to

ensure inaccessibility information for unauthorized

users.Moreover, the modiﬁcation of vital information

can cause very dangerous case, in which can resist a

false alert and false information or no alarm. So, the

system should diving attackers based on replay such

as the submission of alarm messages related to previ-

ous sessions.

To Monitor Personal Health and Fitness Manage-

ment such as the system monitor a patient who is

self-motivated and takes steps to stay healthy and

ﬁt. This provides some consequent avoid by regular

screening applied by monitoring application and ap-

propriate treatment. For this type, the objective is to

continuous remote monitoring patient to improve the

quality life, which can deﬁne some security require-

ments. Our objective is to ﬁnd and ensure availability

and efﬁcient information. In this sense, a goal is to

counteract his or her activity a ﬁnd to collect human

body function (weight measuring device, and activity

monitors) such as eating, walking and moving. In or-

der to integrate this functionality, the challenge is to

respect requirements security. In such case, a solution

is to assure these two major requirements authentica-

tion and availability a ﬁnd to secure communication.

There are the two most important requirements in any

IoT. A ﬁnd to assure identify patient and respect re-

quirement availability of information at anytime and

anyplace. However, for another requirement, the im-

pact factor of not respect can be treated as function

as to impact factor attacker and if the patient should

respect or not.

Scenario-based Vulnerability Analysis in IoT-based Patient Monitoring System

557

Table 1: Information Nature Security Requirements.

Requirement Blood

glu-

cose

Weight

mea-

suring

device

ECG Heart

beat rate

mea-

suring

device

time

spent

sleep-

ing

walking

time

mea-

suring

device

step

count-

ing

device

speed

mea-

suring

device

calorie

spent

mea-

suring

device

Conﬁdentiality + - + + - - - - -

Integrity + - + + - - - - -

Authentication + + + + + + + + +

Availability + + + + + + + + +

Data fresh-

ness

+ - + + - - - - -

Non-

repudiation

- - - - - - - - -

Authorization + - + + - - - - -

Data privacy + - + + - - - - -

Resiliency + - + + - - - - -

Fault tolear-

ance

- - - - - - - - -

3.2.2 Security Requirements Depending On The

Context

The patient in nature didn’t have the static place.

For example, he or she moves from home to another

provider. In this case, different networks have differ-

ent security conﬁgurations and settings.

Such as, when patient walking or moving by pub-

lic transport or vehicle transport many other people,

the neighbourhood can intercept by the active or pas-

sive attack. This attack can be potential affect patient

in which depends on user class patient. For example,

political user has a higher potential attack compares

to the simple user. So, the other problem that can be

allowed is what is the solution when the connectivity

is not possible.

The challenge is to ensure availability information

at anytime and at anyplace, to allow security require-

ments resist to various threat and attack that can mod-

ify, impersonation and eavesdropping or be replaying

information. The challenge is to ensure availability

information at anytime and at anyplace, to allow se-

curity requirements resist to various threat and attack

that can modify, impersonation and eavesdropping or

be replaying information.

Therefore, developing mobility security require-

ments can be a serious challenge. According to the

Table 2, the context can be divided into six categories:

at home, moving, coffee visit, main activity, restau-

rant visit, and shopping. Therefore for each category,

they can be classiﬁed into four other categories that

involved as following:

• Time: Refers to the speciﬁc period in which the

patient interacts with the system to monitor an ac-

tivity of workouts routines or measuring some dis-

eases. It constant supervision by vital sign moni-

tors or activity monitors.

• Neighborhood: Depends on environment patient

and other people can intercept by the active or pas-

sive attack.

• User Class: Depends user class patient such as a

political user or a simple user.

• Access Network: Depends on to the location of

the patient in or out home. The system should be

able to ensure the availability information.

Due to the sensitive nature of the sensor, WBSN

could be easily replayed by the adversary. In this case,

we need to ensure minimize security threats as fol-

lowing: Conﬁdentiality, Authorization, Integrity, Re-

siliency, Authentication, Availability, Data freshness,

and Data privacy. So, the other problem that can be

allowed is what is the solution when the connectivity

is not possible.

Challenge Access Network. Wireless Body Sensor

Networks was used to measuring blood glucose (BG)

a ﬁnd to monitor a diabetic patient in the different

context of at home moving, coffee visit, main activ-

ity, restaurant visit, and shopping.

4 CONCLUSION

This paper proposed two major contributions are

twofold. First, we proposed a design a healthcare ap-

plication in IoT. Second, we discuss to identify the as-

SECRYPT 2017 - 14th International Conference on Security and Cryptography

558

Table 2: Context Security requirements.

Requirement At

home

Moving Coffe

visit

Main

activity

Restaurant

visit

Shopping

Conﬁdentiality + + + + + +

Integrity + - - + - -

Authentication + + + + + +

Availability + + + + + +

Data freshness + + + + + +

Non-repudiation - - - - - -

Authorization + + + + + +

Data privacy + + + + + +

Resiliency + - - + - -

Fault tolearance - - - - - -

sociations between the varying vulnerabilities related

to the data collected while a patient is operating in

normal life and the security threats he or she is ex-

posed to the major result consists in a mapping be-

tween the steps of the generic life scenario and the

security requirements. This result is very useful of

adaptive security approaches.

ACKNOWLEDGMENT

This research has collaborated with innovation centre

(Elgazala technopark).

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