

Since most of the communication protocols have not been specifically designed for the needs of connected medical devices, there is a need to evaluate the available IoT communication technologies in terms of security, in the context of medical devices. For example, smart hospitals integrate IoMT to “provide optimised and the automated processes built on an Information and Communication Technologies (ICT) environment of interconnected assets, particularly based on IoT, to improve existing patient care procedures and introduce new capabilities”. IoMT allows the coupling of IoT communication protocols with medical systems and devices, in order to support real-time, remote patient monitoring and treatment. In the healthcare sector, IoT devices, also known as Internet of Medical Things (IoMT), may support core functions of healthcare or health-related services. Since IoT technologies are utilized in various sectors with different security requirements and needs, they are not always designed having in mind the specific threat landscape of a particular sector. Indeed, the increase of interconnectivity and interoperability of previously isolated systems create new attack paths for remote adversaries. Recent real-world incidents and proof of concept attacks have demonstrated the rise of IoT-enabled attacks in all these sectors.
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Despite the obvious operational and functional benefits, the integration of IoT technologies has also led to new attack opportunities for remote adversaries. Although similar to modern cyberphysical systems, IoT incorporates a wide area of applications in various sectors, including smart energy grids, industrial control systems, healthcare, transportation, home appliances and wearables. The term Internet of Things (IoT) refers to a wide range of interconnected objects and devices that harvest information from the environment through sensors, analyze it and act back on the physical world through actuators. Based on realistic attacks we identify available mitigation controls that may be applied to secure IoMT communications, as well as existing research and implementation gaps. We examine the inherent security characteristics and limitations of IoMT-specific communication protocols. Then we describe the main characteristics of IoT communication protocols used at the perception, network and application layer of medical devices. In this paper we classify IoT communication protocols, with respect to their application in IoMT. Since most of the communication protocols have not been specifically designed for the needs of connected medical devices, there is a need to classify the available IoT communication technologies in terms of security. However, the interconnectivity of critical medical devices with other systems in various network layers creates new opportunities for remote adversaries. The Internet of Medical Things (IoMT) couples IoT technologies with healthcare services in order to support real-time, remote patient monitoring and treatment.
