Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Near Field Communication (NFC) is a promising technology that provides many advantages for applications in the medical service domain. In this paper, we present a comprehensive study of the NFC technology and its security requirements for healthcare applications. We also introduce a new classification of NFC system attacks using a novel multi-dimensional representation. The proposed classification considers three main perspectives to categorize attacks on NFC systems for healthcare applications. These perspectives are: mode of operation, programmability level, and life cycle. Using the proposed classification, we explore the possible threats to NFC systems in healthcare applications and discuss possible vulnerabilities and challenges related to NFC security in the healthcare field. <s> BIB001 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Abstract Objective To report the results of a systematic literature review concerning the security and privacy of electronic health record (EHR) systems. Data sources Original articles written in English found in MEDLINE, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database. Study selection Only those articles dealing with the security and privacy of EHR systems. Data extraction The extraction of 775 articles using a predefined search string, the outcome of which was reviewed by three authors and checked by a fourth. Results A total of 49 articles were selected, of which 26 used standards or regulations related to the privacy and security of EHR data. The most widely used regulations are the Health Insurance Portability and Accountability Act (HIPAA) and the European Data Protection Directive 95/46/EC. We found 23 articles that used symmetric key and/or asymmetric key schemes and 13 articles that employed the pseudo anonymity technique in EHR systems. A total of 11 articles propose the use of a digital signature scheme based on PKI (Public Key Infrastructure) and 13 articles propose a login/password (seven of them combined with a digital certificate or PIN) for authentication. The preferred access control model appears to be Role-Based Access Control (RBAC), since it is used in 27 studies. Ten of these studies discuss who should define the EHR systems’ roles. Eleven studies discuss who should provide access to EHR data: patients or health entities. Sixteen of the articles reviewed indicate that it is necessary to override defined access policies in the case of an emergency. In 25 articles an audit-log of the system is produced. Only four studies mention that system users and/or health staff should be trained in security and privacy. Conclusions Recent years have witnessed the design of standards and the promulgation of directives concerning security and privacy in EHR systems. However, more work should be done to adopt these regulations and to deploy secure EHR systems. <s> BIB002 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Amidst an explosion in digital health product and service investment, increasingly identified cybersecurity vulnerabilities, and a scattered regulatory framework, the digital health marketplace requires a clear, measured approach to consumer safety and data privacy. While legal and technology scholars have generally proposed increased activity in and examination of cybersecurity, neither have taken a multi-disciplinary approach, leveraging both technology and law to advance a regulatory framework for digital health. Leveraging existing U.S. Food and Drug Administration processes with enhanced oversight will create the framework necessary to simultaneously protect patients while providing clear direction for businesses producing digital health products and services. The Federal Food, Drug, and Cosmetic Act is well-positioned to regulate cybersecurity for the United States digital health marketplace. <s> BIB003 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Internet enabled medical devices offer patients with a level of convenience. In recent years, the healthcare industry has seen a surge in the number of cyber-attacks. Given the potentially fatal impact of a compromised medical device, this study aims to identify vulnerabilities of medical devices. Our approach uses Shodan to obtain a large collection of IP addresses that will be passed through Nessus to verify if any vulnerabilities exist. We determined some devices manufactured by primary vendors such as Omron Corporation, FORA, Roche, and Bionet contain serious vulnerabilities such as Dropbear SSH Server and MS17-010. These allow remote execution of code and authentication bypassing potentially giving attackers control of their systems. <s> BIB004 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> A Telecare Medical Information System (TMIS) enables doctors and physicians at a medical center to provide remote care via Internet to the registered patients at any place. Considering the privacy of the patients, medical data, secure and authenticated access to the medical data located at the medical severs are required. Recently, numerous states of the art authentication schemes are proposed in the literature to increase security of the Telecare Medical Information System (TMIS). This paper presents a comprehensive survey and taxonomy of these authentication schemes and classifies them based on the authentication methods applied in each scheme. In addition, a complete list of security attacks which can be conducted against the authentication schemes in the TMIS is provided, and the security capabilities of each scheme and their vulnerability to these attacks are discussed. Furthermore, the proposed authentication schemes are compared, and their advantages, properties and limitations are highlighted. Finally, the concluding remarks and open research issues in TMIS authentication schemes are provided. <s> BIB005 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Implantable medical devices (IMDs) are electronic devices implanted within human body for diagnostic, monitoring, and therapeutic purposes. It is imperative to guarantee that IMDs are completely secured since the patient’s life is closely bound to the robustness and effectiveness of IMDs. Intuitively, we have to ensure that only the authorized medical personnel and IMD programmer can access the IMD. However, in recent years, several attacks have been reported which can successfully compromise a number of IMD products, e.g., stealing the sensitive health data and issuing fake commands. Up to now, there is no commonly agreed and well-recognized security standards and the protection of IMD is still an open problem. In this paper, we present a comprehensive survey of the existing literature on IMD security, with a focus on the access control schemes to prevent unauthorized access. Specifically, we first reviewed the security incidents, IMD threat model and the development of regulations for IMD security. Next, we classified existing IMD access control schemes based on architecture, type of keys used, access control channel, and logic. We also analyzed how different access control models can be adopted to secure IMD. Besides, we particularly discussed the viability of online authentication and low/zero power authentication in the IMD context. <s> BIB006 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> BACKGROUND ::: The adoption of healthcare technology is arduous, and it requires planning and implementation time. Healthcare organizations are vulnerable to modern trends and threats because it has not kept up with threats. ::: ::: ::: OBJECTIVE ::: The objective of this systematic review is to identify cybersecurity trends, including ransomware, and identify possible solutions by querying academic literature. ::: ::: ::: METHODS ::: The reviewers conducted three separate searches through the CINAHL and PubMed (MEDLINE) and the Nursing and Allied Health Source via ProQuest databases. Using key words with Boolean operators, database filters, and hand screening, we identified 31 articles that met the objective of the review. ::: ::: ::: RESULTS ::: The analysis of 31 articles showed the healthcare industry lags behind in security. Like other industries, healthcare should clearly define cybersecurity duties, establish clear procedures for upgrading software and handling a data breach, use VLANs and deauthentication and cloud-based computing, and to train their users not to open suspicious code. ::: ::: ::: CONCLUSIONS ::: The healthcare industry is a prime target for medical information theft as it lags behind other leading industries in securing vital data. It is imperative that time and funding is invested in maintaining and ensuring the protection of healthcare technology and the confidentially of patient information from unauthorized access. <s> BIB007 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Networked medical and healthcare devices and their applications are already creating an Internet of Medical Things which is aimed at better health monitoring and preventive care. But the new concepts and applying of new technologies bring certain risks including failures of devices, infrastructure which may lead to the worst outcome. This paper presents an approach to develop a Markov models set for a healthcare IoT infrastructure that allows taking into account safety and security issues. In addition, it is presented a case study with a Markov model considering attacks on vulnerabilities of the healthcare IoT system. <s> BIB008 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Electronic healthcare technology is prevalent around the world and creates huge potential to improve clinical outcomes and transform care delivery. However, there are increasing concerns relating to the security of healthcare data and devices. Increased connectivity to existing computer networks has exposed medical devices to new cybersecurity vulnerabilities. Healthcare is an attractive target for cybercrime for two fundamental reasons: it is a rich source of valuable data and its defences are weak. Cybersecurity breaches include stealing health information and ransomware attacks on hospitals, and could include attacks on implanted medical devices. Breaches can reduce patient trust, cripple health systems and threaten human life. Ultimately, cybersecurity is critical to patient safety, yet has historically been lax. New legislation and regulations are in place to facilitate change. This requires cybersecurity to become an integral part of patient safety. Changes are required to human behaviour, technology and processes as part of a holistic solution. <s> BIB009 </s> Survey: Cybersecurity Vulnerabilities, Attacks and Solutions in the Medical Domain <s> II. RELATED REVIEWS/SURVEYS, CONTRIBUTIONS <s> Background ::: Over the past decade, clinical care has become globally dependent on information technology. The cybersecurity of health care information systems is now an essential component of safe, reliable, and effective health care delivery. <s> BIB010
In this section, salient features of existing reviews/surveys are extensively discussed. The medical care has got global popularity over the last decade due to the involvement of IoTs and its heavy reliance on information technology. The cybersecurity of the Medical Care Information system (MCIS) is now a crucial component of reliable, safe and effective medical care delivery. The cybersecurity is one of the greatest threats for IoT-enabled medical devices. Jang-Jaccard and Nepal  presented the vulnerabilities in existing software, hardware and network layers. New attack patterns were discussed that affected the emerging technologies such as cloud computing, social media, critical infrastructure smartphone technology. With advent of the latest technology in the medical domain, there is a great possibility of vulnerabilities and attacks on medical technology. An extensive survey of implantable medical devices including security, privacy risks, and patient safety was produced by Camara et al.  . Regarding healthcare technologies, a survey of the progress of IoT-enabled health technology was provided by Riazul Islam et al.  ; the review also discusses stateof-the-art network architectures, industry development, and privacy and security characteristics, including security requirements and threat models. Finally, an intelligent collaborative security framework was proposed to reduce security hazards. An interesting survey regarding devices based on wireless body area networks used in the medical field was presented by Al-Janabi et al.  . The survey focused on privacy and security requirements for those healthcare devices. Malasri and Wang  presented a survey of healthcare implantable devices and discussed some attacks (eavesdrop and spoofing) on implantable devices. The methodical study of IoT for eHealth was discussed by Ida et al.  ; the study also discussed IoT healthcare security challenges. McMahon et al. BIB004 extensively discussed IoT-enabled medical devices. However, the survey attempted to detect the vulnerabilities of compromised medical devices only. Another good survey presented by Masdari and Ahmadzadeh BIB005 discussed the authentication taxonomy of the telecare medical system (TMS). Furthermore, the authentication approaches of TMS are compared, and limitations and advantages of TMS are highlighted. Strielkina et al. BIB008 presented a case study regarding the vulnerabilities of healthcare IoT by using only the Markov model. However, few vulnerabilities were highlighted due to the limitations of the Markov model. A promising review of the medical service field is presented by Alzahrani et al. BIB001 . This review focused on the near-field communication required for healthcare applications. Furthermore, the attack categorization of near-field communication is provided. Wu et al. BIB006 present a detailed survey on implantable medical devices, with an emphasis on access control approaches for avoiding unauthorized access. Another survey regarding cyber security challenges in healthcare was provided by Kruse et al. BIB007 . Jalali et al. BIB010 presented the bibliometric analysis of the literature on Health care and cybersecurity. This is one of the interesting reviews that highlight the publication-contribution percentage and research gap from the cybersecurity perspective. The publications involved the non-technological variables, the business community, software development security and physical security. According to this survey, physical security requires more attention because many physical attacks lead to breaches and harm the safety of the patient. McDermott et al.  conducted survey to determine the potential threat classifications for protecting Electronic Health Record (HER) information. The threats were classified into five categories; portable devices, physical, technical, insider use and administrative. Coventry and Branley BIB009 discussed the cybersecurity breaches including ransomware attacks on hospitals and health information theft. Furthermore, attacks on entrenched medical devices were deliberated. Fernández-Alemán et al. BIB002 reported the systematic literature review result focusing on the security and privacy of EHR systems. Review further suggested to design the standards and the pronouncement of directives regarding security and privacy for EHR systems. Charlotte BIB003 presented the overview of IoT and possible cybersecurity threats in general. After extensively studying these surveys, we determined that all the available surveys are of great importance. However, these surveys either focus on the security and privacy of implantable medical devices from an IoT perspective or authenticate the devices using specific models and case studies. In contrast, our state-of-the-art survey presents the flow of information in the medical domain and the main vulnerabilities of cybersecurity in the medical domain, with a particular focus on information storage and IoT connection. Furthermore, cyber security attacks regarding dataflow in the medical field are extensively discussed. Dataflow attacks are characterized into four categories: information collection attacks, database attacks, website attacks and operation device attacks. Finally, the medical architecture of cybersecurity is classified and briefly discussed. The contributions of this paper are as follows: Background information and the relationship between the medical field and cybersecurity is introduced to describe the basic information of the article. A dataflow model that is efficient for identifying attacks in the medical system is created for the medical domain. A classification of cyber-attacks closely related to the medical field is given, and this classification contributes to the analysis of the advantages and limitations of cyber-attack solutions. A classification of medical cybersecurity architectures in different systems is given, and this classification can be used to address cybersecurity problems. The advantages and drawbacks of various architectures are analyzed with respect to the intelligence medical system, the personal electronic medical system, E-Health archives, the noninvasive ECG sensor system, the implantable imaging system, the comprehensive information system and the hospital information system. Furthermore, we provide reasonable explanations and methods for addressing these problems. A comparison of cybersecurity architecture capabilities, which can be helpful for recommending solutions, is presented. A brief and detailed conclusion that covers all parts of this survey is provided, and a comprehensive comparison and future expectations in the separate areas are discussed.