A literature survey on how Cybersecurity might be

improved in health care.

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Abstract— It has become progressively certain that on the base of the strategic management in health care
Cybersecurity is a risk factor in health care services information. systems, are a theme of maximum interest and rather less
Therefore, many common threats keep on being problematic in approached. In particular, the prospect of at-home health care
medical care. There are deep insights to understand those systems for screening and rehabilitation has raised enormous
threats. Another growing threat in the medical information is the interest and is seen as a new method to approach the disease
medical devices. Medical devices more and more connected to the more efficaciously. With the development of Information
internet, hospital networks, and alternative medical devices to
Technology and its major breakthroughs in health care
produce options that improve health care and increase the
power of health care suppliers to treat patients. A deep literature information systems, bringing the rehabilitation and
survey has been carried out for the techniques and the theories monitoring of the elderly patients from inhospital to more
that are been proposed to improve Cybersecurity in healthcare. advanced at-home health care systems, information security
measures has been raised. A survey of security measures and
data communication security involved in health care systems
Keywords— Cybersecurity, Medical information, Healthcare in order to ensure information protection is presented in this
Devices, Information Security, Vulnerabilities, Threat, Risk factor. paper. The specific security issues involved in the
development of a health care system that manages data to
support monitoring and rehabilitation of patients with
I. INTRODUCTION (Heading 1) Parkinson’s disease is subject of this paper [1].
Earlier the health care information was in the paper format.
Later, this paper format information was transformed into the POStCODE Middleware for Post-market
electronic medical record systems. The electronic health care Surveillance of Medical Devices for Cyber Security in
records management offers advantages related to easy Medical and Healthcare Sector in Australia, Junaid Chaudhry,
accessibility and use of the patient information, no limitation Michael Crowley, Peter Roberts, Craig Valli, Jon Haass
in time, space and human resources for monitoring patients Postmarket surveillance for cyber security of medical
[1]. As we all know that Cybersecurity plays an important role devices is an area within the critical infrastructure of health
in maintaining authenticity and security of the information. care and public health that has been largely neglected. In
This field has become a lead in securing the data. Its main goal developed countries post market quality assurance is passive
is to prevent the data from the unauthorized access and usage following complaints from the health care institutions to the
for any unfair means. Similarly, Cybersecurity also plays a manufacturers of the medical devices. Recently, the individual
vital role in the health care. The information that is authentic devices can be made traceable allowing any malfunctions to
and secured may consists the information about the patient. As be uniquely identified in each device. There is a lack of clarity
there is inclusion of various devices in the health care, it has on post-sale ownership and management of devices and the
become more important to secure the devices for the health updates to the device software. These devices, once plugged
care providers. Health care industries are slow to respond and into Healthcare Information Systems (HIS) act as FDA
are lagged behind other industries in terms of Cybersecurity. approved black boxes that cannot be patched, updated, or
secured by anyone other than the manufacturer. Moreover,
these unpatched devices provide back doors to cyber criminals
II. LITERATURE REVIEW to invade the HIS. These devices are soft targets for cyber
A Security Approach for Health Care Information criminals. So far, we have not come across any mechanisms
Systems, Iuliana Chiuchisan, Doru-Gabriel Balan, Oana that address the surveillance of these devices for cyber
Geman, Iulian Chiuchisan, Ionel Gordin security. In this paper, we analyzed the post-sale surveillance
From the perspective of services to the population, regulations in Australia. Based on our findings, we present
with vast social implications, in which the security, fog-based POSTmarket SurveillanCe Of DEvices
confidentiality, and access to personal data represents a critical (POStCODE) middleware that provides the operational details
region, the medical services and information systems that are (excluding the private data of patient) of the devices directly
to the manufacturers. The introduction of the POStCODE will Cyber Attacks Classification in IoT-based-
give device manufacturers the means to closely monitor the Healthcare Infrastructure, Amir Djenna, Diamel Eddine
functioning of their devices. Manufacturers will be able to Saïdouni
upgrade devices, patch security vulnerabilities and monitor Internet of Things (IoT) is one of the most promising
device performance thereby enhancing health care outcomes. technologies that has captured the attention of industrials and
The POStCODE middleware enhances device security whilst academics in recent years. This technology offers a huge add
building partnerships between the health care facilitators and value to many sectors such as home automation, transport,
the device manufacturers [2]. energy and especially health. However, IoT-based healthcare
suffers from several security issues that are varied from other
Developing Countries and e-Health Services, Leonid. domains in terms of methodologies, motivation, and
Androuchko, Isao Nakajima consequences, due to the complexity of the environment and
The Telecommunication Development Bureau (BDT) the nature of the deployed devices. This paper provides an
of the International Telecommunication Union (ITU) has overview of the most recent security issues for IoT based
formed the Study Group 2 of the ITU Development Sector to healthcare. Particularly, we discuss the probable threats and
answer the need to implement of Telemedicine which was vulnerabilities, and we provide new classification of cyber-
widely addressed and questioned since the World attacks that may affect the healthy functioning of such
Telecommunication Development Conference in Buenos infrastructures [5].
Aires. The Conference noted that “the widespread use of
telemedicine services could allow universal health access and Cyber-physical systems in healthcare
consequently facilitate the solution of the principal health networks, Delia Ioana DOGARU, Ioan DUMITRACHE
problems connected with infectious diseases, pediatrics, This paper presents the role of cyber-physical
cardiology etc., particularly in areas where medical structures systems in healthcare networks, proposes a general framework
are inadequate or non-existing.” Although Telemedicine will for the interconnected medical or medical related devices and
give benefit to any countries, it will be especially very helpful service and discusses security problems. The motivation for
in developing countries, because these countries normally choosing this topic resumes to the evolution of healthcare
faced with problem of inadequate of lack of medical systems and lack of concern for security in the medical sector
infrastructure. Implementation of E-Health services requires [6].
multidisciplinary collaboration, with the active participation of
telecommunication operators and health care professionals. Health care technology management applied to
There is a need to bridge the gap between the public primary care health, Saulo José Argenta Garcia, Rubia
telecommunication and health care communities at all levels. Alves da Luz Santos, Priscila Sousa de Avelar, Renato
National Ministries of Health and Telecommunications also Zaniboni, Renato Garcia
need to work together towards introduction of a The Institute of Biomedical Engineering, Federal
EHealth/telemedicine policy and achievement of universal University of Santa Catarina (IEB-UFSC) for over three years
service where emergency services, health and social to develop from the Municipal Health Secretariat of
information systems are concerned. The creation of national Florianopolis (FLN-SMS) a project management technology
associations, committees, task forces and the like, with a medical and hospital (gTMH) in establishments health care
multidisciplinary composition, is necessary to bring together (EAS) in primary care. This work is conducted by a Local
telecommunication and health professionals, lawyers, industry Center of Clinical Engineering (CELEC), supported by the
and others to assist with awareness-raising at national level various areas that make up the Centre for Management and
[3]. Development of Technology Medical and Hospital (TMH-
Ceged) of IEB-UFSC. In this center are developed
Implementation of E-Health Care System using Web methodologies for the management of hospitalmedical
Services and Cloud Computing, Unnati Dhanaliya, Anupam technology that are applied in Health Centers (SC) of SMS-
Devani FLN. This methodology is focused on managing a proposal
For economical, technological and social based on analyzing the process that involves the whole cycle
development of any country needs enhanced health care of technology healthcare. The deployment of this system in
system. Development of health care system necessitates large the CS of SMS-FLN has presented an important impact on the
no of manpower, especially when a patients needs continuous quality of health care in public primary care of the
monitoring. Power of information and communication municipality of Florianópolis – SC [7].
technology provided efficient and effective solution to health
care system. Using Internet of Things (IoT) condition of a Cyber-physical systems security—A survey,
patient can be monitored and controlled remotely. In this Abdulmalik Humayed, Jingqiang Lin, Fengjun Li, Bo Luo
paper we present E-Health care system by using cloud With the exponential growth of cyber-physical
computing and web services. Use of cloud computing made systems (CPSs), new security challenges have emerged.
remote monitoring and controlling possible. It provides Various vulnerabilities, threats, attacks, and controls have
automatic update of measured parameter of patient as well as been introduced for the new generation of CPS. However,
it sends alert mail by using SMTP (Simple Mail Transfer there lacks a systematic review of the CPS security literature.
Protocol) [4]. In particular, the heterogeneity of CPS components and the
diversity of CPS systems have made it difficult to study the
problem with one generalized model. In this paper, we study resources and citizens in an event of biological terror or
and systematize existing research on CPS security under a natural disasters [10].
unified framework. The framework consists of three
orthogonal coordinates: 1) from the security perspective, we Systems Health Care the aspect of home and medical
follow the well-known taxonomy of threats, vulnerabilities, care, Hiroshi Nakajima, Toshikazu Shiga, Yutaka Hata
attacks and controls; 2) from the CPS components perspective, The importance of measuring vital signs and life style
we focus on cyber, physical, and cyberphysical components; activities in ordinary life besides in medical field has been
and 3) from the CPS systems perspective, we explore general realized more and more. This is because the affect of life style
CPS features as well as representative systems (e.g., smart disease in super aging society has been strongly associated
grids, medical CPS, and smart cars). The model can be both with long term nursing care. Additionally, sensing and
abstract to show general interactions of components in a CPS information technology has been developed for realizing ease
application, and specific to capture any details when needed. of use, cost reduction, and low intrusion. In this article,
By doing so, we aim to build a model that is abstract enough systems approach to health care is developed by centering
to be applicable to various heterogeneous CPS applications; home and medical care. The essence of the notion is using
and to gain a modular view of the tightly coupled CPS sensory data of vital signs and life style activities in both
components. Such abstract decoupling makes it possible to medical field and home by bridging between them to make
gain a systematic understanding of CPS security, and to medical treatment and home self-care efficient and effective.
highlight the potential sources of attacks and ways of Systems Health Care mainly composes of Health Management
protection. With this intensive literature review, we attempt to and Knowledge Harvesting technologies. First one is designed
summarize the state-of-the-art on CPS security, provide for continuous health care and improvement by applying
researchers with a comprehensive list of references, and also index, criterion, and causality. The second is for causal
encourage the audience to further explore this emerging field knowledge extraction process from sensory database, which is
[8]. used in Health Management. The notion and the technologies
are studied and discussed in the article. Application studies
A Smartphone based Application to Improve the follow them by centering health care supporting system and
Health Care System of Bangladesh, Ahmed Imteaj, employing both vital signal and life style activities monitoring.
Muhammad Kamrul Hossain Blood pressure analysis program used in medical field as vital
Nowadays, smartphones have reached every hand signal monitoring is employed. Regarding life style activities,
and every home. As a result, people are making use of the active mass monitoring, non-contact sleep monitoring, and
beneficial mobile applications to make their everyday life weight-loss programs are introduced [11].
easier. This paper focuses on development of a mobile
application(app) to help providing an effective health care Probabilistic Threat Detection for Risk Management
system. Using this app people can get numerous benefits like in Cyber-physical Medical Systems, Aakarsh Rao, Nadir
finding hospital information in the city, information about Carreón, Roman Lysecky, and Jerzy Rozenblit
cabin, cabin booking with payment, intelligent suggestion on Medical devices are complex cyber-physical systems
choosing suitable hospital, finding a doctor, emergency exposed to numerous security risks and vulnerabilities. This
service calling, first aid information, alarm system for article presents a dynamic risk management and automated
medication, Body Mass Index (BMI) calculator etc. This threat mitigation approach based on a probabilistic threat
application will be a helping hand for people who find it estimation framework. A smart-connected pacemaker case
difficult to select hospital, book cabin, contacting doctor for study illustrates the approach [12].
appointment or seeking help in emergency situation. Besides,
it will help the masses in their everyday life by providing Testing Health-care Integrated Systems with
health care information, aid and medication information, anonymized test-data extracted from Production Systems, Ali
medicine reminder system, etc [9]. Raza, Stephen Clyde
Testing of data-centric health-care integrated systems
Future Delivery of Health Care: Cybercare, C. involve numerous non-traditional testing challenges,
Everett Koop, Robyn Mosher, Luis Kun, Jim Geiling, Eliot particularly in the areas of input validation, functional testing,
Grigg, Sarah Long, Christian Macedonia, Ronald C. Merrell, regression testing, and load testing. For these and other types
Richard Satava, Joseph M. Rosen of testing, the test-data suites typically need to be relatively
Health-care system reforms can change the structure large and demonstrate characteristics that are similar to real
of the current U.S. health-care system, from centralized large data. Generating test-data for integrated system is problematic
hospitals to a distributed, networked healthcare system. In our because records from different systems need to be inter-related
model, medical care is delivered locally in neighbourhoods in realistic and less-than perfect ways. Using real-data is also
and individual homes, using computer technologies like not a feasible choice, because health-care data contains
telemedicine, to link patients and primary care providers to sensitive personal identifying information (PII). As a
tertiary medical providers. This decentralization could reduce foundation, this paper provides a classification of testing
costs enough to provide all citizens with medical insurance challenges for health-care integrated systems and a
coverage; it would benefit patients and providers; and as a comparison of anonymization techniques. It also narrates our
dual-use system, it would better protect the country’s experiences with a test-data creation tool [13] that extracts and
anonymizes loosely correlated slices of data from multiple
operational health-care systems while preserving those real three dimensions. The dimensions are different domains of
data characteristics, discussed under the classification scheme smart grid, different hierarchies of the proposed information
[13]. and communication model, different stages of the information
Security Management in Health Care Information system life cycle. Also, a comparison of these standards is
Systems, Berglind Fjola Smaradottir made. After discussed, studied and analyzed, an information
Health care information systems play an important security standard architecture is designed and described to
role for communication across the organizational borders of guide the electric power utilities in their smart grid
health care services. The electronic health record represents information security efforts [16].
the main entity in the management, exchange and storage of
medical information. Health care organizations must adopt Information Security Protection in Software Testing,
strategies for security and privacy risks associated with access Yubin Wang, Jinyu Yao, Xiaoxue Yu
to health care information systems, but on the other hand, the At the present, information security protection for
information needs to be accessible and readable for authorized software testing is faced with serious situation. There are risks
health care professionals carrying out patient treatment. This of software information interaction and transmission
paper presents a literature review on security management in throughout the life cycle in software testing process. Lack of
health care information systems. The aim was to analyze information security protection and technical support will
descriptions and definitions of information security policy, result in important information leakage, such as the source
access control management and the usability of security code leakage, etc. By analyzing the leakage way of software
solutions [14]. information, a method in accordance with the information
security requirements is elaborated which composed by
OpenEHR aware multi agent system for technology framework, Controlled library, and test data
interinstitutional health data integration, Vieira-Marques P., security etc. The method is throughout the life cycle of
Bacelar-Silva G., Patriarca-Almeida J., Robles S., Frade S., software testing process in order to ensure the security of
Cruz-Correia R. software testing [17].
Most patients receive care from many health care
providers, and consequently their health data is dispersed over Seamless Personal Health Information System in
many institutions' paper and EHR-based record systems. This Cloud Computing, Wan-Young Chung
reality leads to a fragmented system of storing and retrieving Noncontact ECG measurement has gained popularity
essential patient data that impedes optimal care leading to the these days due to its non-invasive and conveniences to be
coexistence of somewhat autistic systems. Providing means applied on daily life. This approach does not require any direct
for scattered clinical information to be congregated where and contact between patient’s skin and sensor for physiological
when needed may have a strong impact on healthcare quality. signal measurement. The noncontact ECG measurement is
Interoperability is a major requisite for effectively sharing integrated with mobile healthcare system for health status
information between systems. Standards like openEHR play monitoring. Mobile phone acts as the personal health
an important role on achieving interoperability. Agents are information system displaying health status and body mass
software entities, which can embody different perspectives of index (BMI) tracking. Besides that, it plays an important role
the surrounding environment and act accordingly. They can being the medical guidance providing medical knowledge
perceive the dynamic character of the environment and update database including symptom checker and health fitness
their knowledge, enabling pro-activeness regarding actions guidance. At the same time, the system also features some
that are better suited according to a particular user and a given unique medical functions that cater to the living demand of the
set of goals. In this work we extend our previous work of patients or users, including regular medication reminders, alert
building a VEPR for inter-institutional data integration with alarm, medical guidance, appointment scheduling. Lastly, we
the inclusion of openEHR usage for querying and storing data demonstrate mobile healthcare system with web application
in order to pursuit the efforts towards Health Information for extended uses, thus health data are clouded into web server
Systems semantic interoperability [15]. system and web database storage. This allows remote health
status monitoring easily and so forth it promotes a cost-
Smart Grid Information Security – A Research on effective personal healthcare system [18].
Standards, WANG YuFei, ZHANG Bo, Lin WeiMin, ZHANG
Tao Poster Abstract: Analysis of Cyber-Security
Smart Grid has received tremendous development Vulnerabilities of Interconnected Medical Devices, Yanchen
momentum over the last years. Information and cyber security Xu, Daniel Tran, Yuan Tian, Homa Alemzadeh
of smart grid faces severe challenges and has gained
considerable importance. First, the characters of smart grid are With advances in sensing, networking, and
analyzed and discussed. Then a hierarchical information and computing, smart medical devices have been widely deployed
communication model is abstracted. Based on the proposed in various clinical settings. However, cyber attacks on hospital
model, the information security risks and information security networks and critical medical devices are serious threats to
protection demands of smart grid are studied and summarized. patient safety, security, and privacy. This paper studies the
According to the model and security risks, this paper surveys, cyber-security attacks that target hospital networks and other
collects, and study’s different smart grid and common interconnected clinical environments. Our goal is to
information and cyber security standards and guidelines from characterize threat models in such environments by studying
the public data from vulnerability databases on medical constitute only a part of IS. A comprehensive and integrated
devices and reports on real attacks targeted at hospital view of the security of IS considering all its parts (hardware,
networks. We use a keyword-based approach to identify software, human factor, data, and the impact of real world), is
security reports on medical devices. We summarize our presented in the paper. The design of well-implemented
observations from the analysis of the vulnerability reports and information security management system is the reliable way
provide insights into the types and impacts of vulnerabilities towards the safety of information in a company or in an
[19]. institution [22].

Investigating the Security Threats on Networked

Medical Devices, David Zaldivar, Lo'ai A. Tawalbeh, Fadi III. CONCLUSION
Muheidat Today, due to automation, there is a huge amount of
This paper explores the cyber security threat of data that has been produced. The healthcare organisations are
Implanted Medical Devices. The widely use of Internet of not able to fully manipulate the data as the data is in huge
Thing capable devices in healthcare like pacemakers, infusion amount. Including manipulation, security of this data is also
pumps, and insulin pumps support patients, at the same time become an important aspect. Space is not the issue but to
they are considered a point of security threats. All of these secure the data in the given span of time might be the major
devices are susceptible to hacking and exploitation, which has factor affecting the authentication of the data. As we all know
been demonstrated at various cyber security conventions for that huge amounts of data can be stored in the cloud storage
nearly the past decade. Although some progress in security but to secure the cloud storage is the challenging part. IoT-
measures seems to have been made, recent discoveries and based devices used in healthcare also needed to be secured as
interviews with researchers show a battle is still being fought the sensors of the IoT based devices produce large amount of
with some manufacturers. Through pressure applied by some data.
of these researchers, The Food and Drug Administration As the data includes the personal information of the
(FDA) has taken notice and issued safety warnings for some patients, it needs to be secured and prevent from getting the
of these devices. We will begin by defining what these devices data into the hands of the unauthorized person. The databases
are and explore why people need them. Next, we will briefly that include the medical information should be secured
give a history of the Internet of Things, explore prior security because the exploiters can inject the vulnerable content in the
issues, and then introduce the security researchers and groups database as well. There are various mechanisms used to secure
involved with finding the exploits of healthcare devices [20]. the medical information from getting exploited by the
unauthorized users. So, here was the deep literature survey
From WannaCry to WannaDie: Security Trade-offs about how Cybersecurity might be improved in Health care.
and Design for Implantable Medical Devices, Guanglou
Zheng, Guanghe Zhang, Wencheng Yang, Craig Valli, Rajan
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