This article has been accepted for publication in a future issue of this journal, but has not been
fully edited. Content may change prior to final publication. Citation information: DOI 10.1109/JIOT.2021.3078702, IEEE Internet of
Things Journal
IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021
Mutual Authentication Scheme for the
Device-to-Server Communication in the Internet of
Medical Things
Jiangfeng Sun, Member, IEEE, Fazlullah Khan, Senior Member, IEEE, Junxia Li∗ , Member, IEEE, Mohammad
Dahman Alshehri, Member, IEEE, Ryan Alturki, Member, IEEE, and Mohammad Wedyan , Member, IEEE.
Abstract—Internet of Medical Things (IoMT) is an application-
specific extension of the generalized Internet of Things (IoT) to
ensure reliable communication among devices Ci , designed for
the medical industry. However, a challenging issue associated
with these networks, i.e., IoMT and IoT, is to ensure the au-
thenticity of both source and destination modules and further
guarantee the integrity of the multimodal data the emergencies
such as the COVID-19 pandemic. Various mechanisms for device
authentication have been presented in the literature to resolve
both devices and data’s authenticity, integrity, and privacy. Still,
authentication of mobile device-to-server (in both homogeneous
and heterogeneous IoMT) is not explicitly addressed for the black-
hole attack. In this paper, a device-to-server and vice versa mutual
authentication scheme are presented to ensure secure communi-
cation sessions among numerous mobile devices Ci and server
Sj in the operational IoMT. The proposed scheme is a hybrid of
Medium Access Control (MAC) and enhanced on-demand vector
(EAODV)-enabled routing schemes. In the proposed scheme, an
offline phase is introduced to complete the registration process
of member devices with the concerned server module. It blocks
every possible entry of the potential intruder devices Ak in the
operational IoMT. A mobile device, Ci , interested in initiating a
communication session with a particular Server Sj , is needed to
pass the mutual authentication process. As a result, only registered
devices Ci are allowed to communicate. Additionally, a reliable
encryption and decryption scheme is used to ensure data reliability
during these communication sessions. Simulation results verify the
exceptional performance of the proposed mutual authentication
scheme in terms of authenticity, security, and integrity of both
devices and data in the operational IoMT.
Index Terms—IoMT, IoT, COVID-19, Authentication, Privacy,
Security.
I. I NTRODUCTION
The Internet of Things (IoT) is used to facilitate human
beings in improving the life stander of people worldwide by
periodically monitoring various activities. It should provide
J. Sun is College of Computer Science and Technology, Henan Polytechnic
University, Jiaozuo 454000, China
F. Khan is with the Department of Computer Science, Abdul Wali Khan
University Mardan, KPK, 23200, Pakistan
J. Li is with the School of Physics and Electronic Information Engineering,
Henan Polytechnic University Jiaozuo 454000, China
M. Alshehri is with the Department of Computer Science, College of
Computers and Information Technology, Taif University, 11099, Taif, Saudi
Arabia
R. Alturki is with the Department of Information Science, College of
Computer and Information Systems, Umm Al-Qura University, Makkah, Saudi
Arabia
M. Wedyan is with the Faculty of Artificial Intelligence, Al-Balqa Applied
University, Jordan.
∗ shows corresponding author.
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1
proper and timely medication facilities to each individual
(patient), which is possible only if IoT is utilized effectively in
the medical industry [1], [2]. Therefore, the Internet of Medical
Things (IoMT), a specialized branch of IoT dedicated to the
medical industry, is developed to ensure proper medication
facility availability in general and particularly in emergencies
such as the COVID-19 pandemic. In the IoMT-enabled medical
facility, smart and miniature but intelligent sensing devices Ci
capable of collecting data and transmitting it over a distance
are implanted in the human body or placed on or around
the human body (preferably according to disease symptoms).
Doctors can monitor a patient’s health status, particularly from
a disease perspective [3]. Furthermore, the IoMT should play
a vital role in detecting various diseases as ECG signals,
skin resistance, and EEG signals. In emergencies such as the
COVID-19 pandemic, IoMT should be focused on detecting
affected patients (preferably based on main symptoms) and
tracing their origin based on data collected through intelligent
sensors. Generally, in the IoMT, communication between smart
devices (both doctors and patients) is carried out on open access
network [4]. Therefore, these systems are highly susceptible
to numerous potential attacks, i.e., intruder, insider malicious,
privacy protection, and perfect secrecy [5]. Additionally, a
communication mechanism is designed to ensure reliable com-
munication among authentic devices without compromising
numerous performance metrics such as average packet delivery,
end-to-end delay, and throughput of the operational IoMT
networks.
To resolve the issues mentioned above and develop a secure
IoMT numerous authentication and privacy schemes were pre-
sented in the literature designed to ensure the security of data
and member devices Ci . A three-factors-enabled authentication
scheme is introduced to ensure the secure establishment of
session communication sessions in a multi-server environ-
ment based on bilinear pairing [6]. However, this approach
is vulnerable to various attacks such as offline guess and
key impersonation. An extended version of the three-factor-
enable scheme was proposed by Wang et al. [7]. They utilized
hashing function and fuzzy extractor to form a robust authen-
tication scheme. Likewise, a biometric identification system-
based remote user authentication scheme was designed based
on fuzzy extractors, and ECC [8]. Although this scheme was
prune against numerous possible attacks, it was unable to
deduce invalid password problems. A mutual authentication
scheme for the Telecare Medical Information System (TMIS)
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IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021
was presented. However, both patient and doctor use TMIS for
establishing secure communication sessions over the Internet
[9]–[11]. TMIS facilitates patients by providing an in-door
(home) treatment environment. Similarly, bio-hash function
and ECC are integrated by Kumari et al. [12] to develop a
secure authentication system for the medical industry. However,
known-key and critical impersonation attacks are among the
main issues associated with this scheme. In [13], a trust-enabled
and extended ad-hoc on-demand distance vector (EAODV)-
based security scheme is presented. It resolves the black-
hole issue with the resources constraint networks. Likewise,
numerous authentication mechanisms have been proposed to
ensure secure communication sessions among various devices
in the operational IoT [11], [13], [15], [16], [18]. Although
these mechanisms have resolved devices Ci authenticity issue
in the operational IoT, they incur higher communication and
processing cost. Therefore, a lightweight and efficient mutual
authentication scheme is needed to be developed for the IoMT.
In this paper, a lightweight mutual authentication scheme is
presented. The proposed scheme ensures secure communication
sessions between a server and static/mobile devices. The main
contribution of this research work are
1) A lightweight mutual authentication scheme for the IoMT
where mobility of member devices is supported to mimic
the hospitals’ actual operational environment.
2) A reliable communication or routing mechanism to en-
sure communication among member devices Ci and
servers Sj .
3) MAC and EAODV scheme enabled hybrid communica-
tion approach for the IoMT.
4) Smart health monitoring system with embedded secure
device-to-server communication in the IoMT.
The remaining manuscript is organized as follows. In sub-
sequent section II, a comprehensive review of literature is
presented. In section III, a detailed description of the proposed
device-mutual authentication mechanism is shown, and an
informal security analysis of the proposed scheme is presented.
In section V, implementation and numerous findings of the
proposed and existing models in terms of various performance
metrics are presented. Finally, future directions and concluding
remarks are given.
II. R EVIEW OF L ITERATURE
In IoMT, doctors can store and retrieve data about patients
using public or private networks. In these circumstances, secure
establishment and authentication schemes are recommended
to secure the exchange of data from potential attackers or
intruders. Various authentication and security approaches were
presented in the literature to address these issues explicitly for
resource constraint networks such as IoT and IoMT.
To resolve authenticity issues associated with multi-server
environment, a three-factors-based mutual authentication mech-
anism was proposed by Amin et al. [15], which enables those
frameworks to establish secure communication sessions. For
this purpose, a bilinear pairing mechanism was implemented.
However, vulnerability to various intruder attacks such as of-
fline guess and key impersonation are among the primary issue
associated with this approach. To enhanced security and privacy
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2
in the three-factor-enabled mutual authentication scheme, an
extended version of the original approach is proposed by Wang
et al. [7] where hashing function and fuzzy extractor are used
instead of bilinear pairing. In addition to these approaches, a
biometric identification system-enabled remote user authenti-
cation scheme was designed for the resource-limited networks
where fuzzy extractors and ECC are used together to ensure
the authenticity of the source and destination devices [8].
Although this scheme was prune against numerous possible
intruder attacks, it could not resolve various situations such
as invalid password problems. A three factors-enabled user
authentication scheme was developed for the Telecare Medical
Information System (TMIS), which was explicitly focused on
the anonymity of both doctors and patients in the operation
networks [6]. Likewise, Gope et al. [11] have proposed a
secure, anonymous authentication scheme to ensure secure
data access in the wireless sensor networks. Furthermore, an
unknown authentic mechanism for body area networks was
presented to enable secure communication sessions among
numerous authentic devices [9]. Similarly, bio-hash function
and ECC are integrated by Kumari et al. [12] to develop a
secure authentication system for the medical industry.
Additionally, AODV based authentication approaches were
presented to establish a secure communication session between
source & destination modules in the IoT and WSNs [17], [18].
A trusted model-enabled authenticity mechanism was presented
to resolve a scenario where a member device is captured and
intruder device Ak pretended as a legitimate device [19]. A
forge-enabled mutual authentication and routing approach was
developed to resolve various issues associated with the original
AODV based approach [20]–[22]. In this work, the fake route
requests RREQ messages identified intruders in closed proxim-
ity. Similarly, a behavior-based routing scheme with embedded
security measures was developed where un-usual responses
identify intruder devices [23]. A neighborhood node activity-
based authentication scheme was developed where member
devices store vicinity data, i.e., PREQ, MAC, PREP, and
security keys [24]. Similarly, a baited-enabled authentication
approach was developed to resolve the black-hole issue [25].
In this work, a 5 usec bait timer is used by member devices
Ci to misguide the intruder devices. Although these models
have resolved some of the issues, complexity and application
specificity are the closely linked problems with these models.
III. P ROPOSED M UTUAL AUTHENTICATION A PPROACH
Before initiating a proper communication session, the au-
thenticity of devices Ci & Servers Sj is needed to be checked
and verified in the operational IoMT to resolve the black-hole
issue. It is achieved by designing a hybrid mutual authentication
scheme, which utilizes the MAC address of various devices
Ci . The EAODV-enabled approach is used to form a reliable
mutual authentication scheme for the IoMT to guarantee the
authentication of the mobile devices Ci to the concerned
server or cluster head (CH) Sj . To ensure authenticity, every
device Ci ∈ IoM T is bounded to verify its status to the
concerned server Sj . A device Ci is considered authentic if
its MAC address is registered with a server Sj . It should
be a proper member device of a particular server or sink
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IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021 3

module in the operational IoMT. The device Ci registration

process with the concerned server Sj is carried out in the Off-Line Phase
offline phase, completed before the underlined IoMT networks
Mobile Device Ci Server Module Sj
are operational. To guarantee the authenticity of the operating
device Ci , every server Sj is bounded to store information Ci Generates pkt = MAC ⊕ Sj ⊕ EAODV
about Ci in tables. For example, i.e., (i) registered devices Cipher Text = Et
Server = ECDDHP
(ii) member devices. A device Ci is considered a registered Hashing = h [Sj ⊕ pkt]
Et = h [Sj ⊕ pkt]
device if its MAC address is stored in the registration table of Packet in Cipher Form
Sj . At the same time, this device does not have an entry in h[Sj ⊕ pkt]
the member table of server Sj . In the latter case, the MAC Server Module = Decipher pkt
address of a particular device Ci should be available in both Et = h [Bc ⊕ pkt]
Hash Function = h [Bc ⊕ pkt]
tables of the concerned server Sj . In the proposed approach, Sj = ECDDHP
both registered and member devices can send a request for Palin text (pkt) = [ MAC ⊕ Sj ⊕ EAODV]
Find MAC (Ci) = ARP → [Palin text]
the initiation of a communication session(s). Apart from the Sj = Store MAC of Ci
registered and member devices added in the offline phase, entry Bc = [ MAC ⊕ ds ⊕ EAODV]
Sj = ECDDHP
of other devices Ci or servers Sj is prohibited in the operational Hash Function = h [Bc ⊕ pkt]
IoMT to safeguard it from intruder devices Ak . Therefore, if Et = h [Bc ⊕ Pkt]
Packet in Cipher Form
a legitimate device Ci (which is not registered) or an intruder
h[Bc ⊕ pkt]
device Ak tries to initiate a proper communication session with Encrypted data
a particular server Sj . Their requests are not processed and
Ci = Decipher pkt
denied. The authenticity of the interested device Ci is confirmed Et = h [Bc ⊕ pkt]
by the concerned server Sj where the MAC address of this Hash Function = h [Bc ⊕ Pkt]
Bc = ECDDHP
device Ci is part of both registered and member tables of Sj . Palin text (pkt) = [ MAC ⊕ ds ⊕ EAODV]
The proposed model has three phases, i.e., (i) offline (ii) Device Ci store information of ECDDHP and routes info
Off-Line Phase of Ci completed
Authentication (iii) Operational phases as described below.
Fig. 1: Graphical Representation of the Off-line Phase
A. Phase-I: Off-line Registration Process
In this phase, each device Ci is forced to generate a request this message and add these devices to their registered devices
message (RREQ) and send it to that server module Sj , which table or class as the distance of these devices is greater than
is deployed in its communication range. To further secure this the defined threshold value (δ in this case) according to Equ.
mechanism, every message in the off-line phase is encrypted 2.
with well-known encryption mechanisms: Elliptic-curve Delfi  p
Hellman Problem (ECDDHP). The PREQ message holds the 
 ∀i=0...n Ci ∈ (Sj ) iff (xi − Sj )2 + (yi − Sj+1 )2 > δ

MAC of the intended device Ci . The concerned server module 
 p
Sj decrypt this message and adds the concerned MAC to the list ∃i=0...n Ci ∈ (Sj ) if f (xi − Sj )2 + (yi − Sj+1 )2 == δ

that holds legitimate devices’ addresses. A device Ci is added 


where S represents base station or server module

to both table iff it is deployed in the direct communication
range of the concerned server Sj according to Equ. 1. (2)
 p A graphical representation of the working methodology of

 ∀i=0...n Ci ∈ σ(Ci ) iff (xi − Sj )2 + (yi − Sj+1 )2 < δ the offline phase is shown in Figure. 1. The proposed mutual
authentication scheme allows only member devices Ci to start


 p
∃i=0...n Ci ∈ σ(Ci ) if f (xi − Sj )2 + (yi − Sj+1 )2 == δ communication sessions with the intended server Sj . In other
words, if a device, say C1 , is registered and belongs to S1 , then




where S represents base station or server module it can initiate communication session(s) with S1 only.

(1)
When a server module Sj completes the registration process
of the requesting device Ci , then it is notified with an en- B. Phase-II: Authentication Mechanism
crypted message which confirms its authenticity. Likewise, the In this phase, every device Ci ∈ IoM T should be registered
confirmation message is decrypted by the concerned device with the nearest (preferably distance-based) server Sj . The
Ci and updates its metadata accordingly. Secondly, after the process of device authentication is triggered if a device (either
registration process is completed. Every server module Sj is an intruder Ak or legitimate Ci ) sends an encrypted version of
bounded to share its (in encrypted form) authenticated device the request message (RREQ) to the concerned server module
information with other servers. It is beneficial in scenarios Sj to start communication. Initially, the concerned server Sj
where a member device Ci moves from one server, say Sj , decrypts this PREQ message to retrieve the MAC of source
to another server Sj+1 . To realize this, a message with the device Ci . Then it is compared with every entry available
concerned information (preferably about its member devices in the member device table where devices MAC are stored
Ci ) is generated and encrypted by the concerned server Sj , during the offline phase. The source device Ci is allowed to
which is shared with other servers. These servers Sj+1 decrypt start communication with the intended server. If the MAC of

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this device Ci is matched within the specified table means the

source device Ci is a legitimate device. The server S1 generates
an encrypted version of the route reply message (RREP) and
Device Authentication Phase
sends it to the requesting device C1 . Once this message is
received, the requesting device C1 is allowed to start com- Mobile Device Ci Server Module Sj
munication with the concerned server S1 only. Alternatively,
Ci Generates pkt = MAC ⊕ Sj ⊕ EAODV
suppose the MAC of the source device C1 is not matched with Cipher Text = Et
the available MAC address list. In that case, it is either (i) a Server = ECDDHP
Hashing = h [Sj ⊕ pkt]
legitimate or (ii)an intruder device Ak which is clarified further Et = h [Sj ⊕ pkt]
by matching its MAC in the registered devices table. Suppose Packet in Cipher Form
h[Sj ⊕ pkt]
the MAC of the source device C1 is matched with one of
the MAC addresses available in the registered devices table. Server Module = Decipher pkt
Et = h [Bc ⊕ pkt]
In that case, this message is ignored as a legitimate device Hash Function = h [Bc ⊕ pkt]
must be available in both tables, i.e., registered and member Sj = ECDDHP
Palin text (pkt) = [ MAC ⊕ Sj ⊕ EAODV]
devices table. In case-II, the MAC of the source device does Find MAC (Ci) = ARP → [Palin text]
MAC (Ci) ∈ Registered MAC Table
have associated entries in any of these tables. It is identified Accept pkt = Ci
as an intruder Ak , and an encrypted message is shared by the Bc = [ MAC ⊕ ds ⊕ EAODV]
Sj = ECDDHP
intended server module Sj with every member device which Hash Function = h [Bc ⊕ pkt]
contains information about this intrusion. For example, suppose Et = h [Bc ⊕ Pkt]
Packet in Cipher Form
a device, say C1 , is interested in initiating a transmission
session with the concerned server, saying S1 . In that case, it h[Bc ⊕ pkt]
Encrypted data
sends a request message to its intended server module. The Ci = Decipher pkt
concerned server module S1 initially checks the authenticity Et = h [Bc ⊕ pkt]
Hash Function = h [Bc ⊕ Pkt]
of the requesting device C1 by searching the requesting device Bc = ECDDHP
C1 MAD address. If MAC of the source device C1 is found, Palin text (pkt) = [ MAC ⊕ ds ⊕ EAODV]
Ci stores Acknowledgment information
then it is a legitimate device. Otherwise, it is declared as an Authentication Phase of Ci is completed
intruder device Ak . If a device, say Ak , is identified as an
intruder, then its MAC is placed in the blacklist class of the Fig. 2: Graphical Representation of a Legitimate Device-to-
concerned server S1 . A graphical representation of the proposed Server Request and Response Mechanism in the IoMT
mutual authentication scheme authentication phase is described
in Figure 2.

C. Phase-III: Mobility of Member Devices

Mobility of numerous devices Ci is supported in the pro-
Intruder Device Authentication Phase
posed mutual authentication scheme to mimic the basic envi-
ronmental infrastructure of the IoMT as devices or sensors Ci Intruder Device Ak Server Module Sj
are needed to be attached with the patients. In the proposed ap- Ak Generates Packet = (Sj ⊕ 48 bits MAC ⊕ EAODV)
proach, if a device Ci moves from the communication range of Cipher Text = Et
Server = ECDDHP
the concerned server Sj and enters into the domain of another Hash Function = H (Sj ⊕ Pkt)
sever Sj+1 then Ci should inform the concerned server Sj via Et = H (Sj ⊕ Pkt)
Encrypted packet
an encrypted message, PREQ message in this case, before its H (Sj ⊕ Pkt)
movement. The concerned server Sj cancels membership of Encrypted packet
the requesting device Ci by deleting its MAC address from the Server Module = Decrypt Received Packet
member devices table. Once this device Ci reaches its intended Et = H (Bc ⊕ Pkt)
Hash Function = H (Bc ⊕ Pkt)
destination, then it sends an encrypted PREQ message, which Sj = ECDDHP
contains its MAC address and a membership request, to server Palin text (Pkt) = ( Sj ⊕ 48 bits MAC ⊕ EAODV)
Find MAC (Ak) = ARP → (Palin text)
Sj+1 that should be deployed in the wireless communication MAC(Ak) ∉ Registered MAC Table
range of the requesting device according to Equ 3. Denied = Ak
MAC (Ak) is added is to Class Blacklisted
p
 (xi − Sj+1 )2 + (yi − Sj+1 )2 <= δ Malicious Activity
Encrypted packet

where Sj+1 represents base station or server module


Ci Compute = Decrypt Packet
(3) Authentication Request of Ak is Denied.
The concerned server Sj+1 confirms the requesting device Ci
by finding an associated entry in the registered devices table. If
the entry is available, then the MAC of the source device Ci is Fig. 3: Graphical Representation of an Intruder Device-to-
added to the member devices table. Alternatively, suppose the Server Request and Response Mechanism in the IoMT
MAC of the source device does not have an associated entry
in the table of Sj+1 where the MAC of the member devices

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are located. In that case, Ci is identified as intrude device Ak
and its request is denied by Sj+1 .
Theorem-1: A device-to-server Ci − Sj is possible if and
only if Ci is a legitimate device.
Proof: Suppose an intruder device Ak pretends itself a le-
gitimate device Ci and sends a request message (PREQ) to
establish a communication session with the concerned server
Sj . Furthermore, if we assume that this intruder device Ak also
knows the encryption mechanism used by legitimate devices Ci
to encrypt the PREQ message. The concerned server Sj will
allow the requesting device Ak to start this session iff it is an
authentic device Ci . It is possible only if the MAC address
of this intruder device Ak is listed as a registered device.
However, in this case, the MAC of the source device, intruder
device Ak , does not have an associated matched value, and it
is identified as an intruder device Ak . Therefore, the concerned
Sj adds MAC of the source device Ak to the blacklisted
class and sends a ciphertext to the neighboring devices Ci that
Ak is an intruder device. Therefore, permission to initiate a
communication session is denied. Conversely, if the concerned
device Ci is a member device and sends a PREQ message
to the concerned server Sj . The concerned server module Sj
matches the MAC of the device Ci , which is requested, with
the already stored MAC (carried out in an offline phase). A
match is encountered in this case as the source device Ci is
a legitimate device, and its MAC should be there with the
concerned Sj module. Once a device is verified, a ciphertext
is sent to it by the concerned server Sj where permission to
initiate a communication session is granted. Hence, a request
to establish a proper communication session is processed iff
the requesting device Ci is a legitimate device.
D. Phase-IV: Communication Phase
In this phase, a detailed description of the proposed com-
munication approach is presented. Every device Ci should be
associated with a server Sj . If the requesting device Ci is
authentic, it can establish a communication session with the
intended server Sj . If an authentic device Ci moves from the
existing server Sj to another server Sj+1 , then the authenticity
process is repeated. During offline phases, the registration and
membership of every legitimate device Ci are confirmed and
minimizes the entrance probability of the intruder device Ak in
the operational IoMT networks. It is because intruder devices
Ak initiates their task as soon as the underlined IoMT net-
work becomes operational. Moreover, the registration process
of all devices Ci is completed before the network becomes
operational. Therefore, it is tough for an intruder device Ak
to mimic a member device and initiate proper communication
with any server module Sj in the operational IoMT.
The proposed scheme bound every device Ci and server Sj
to set a time-frame in which it will be able to receive a response
RREQ message from each other. In the proposed approach, the
waiting time of every device is equal to the round trip time
(RTT) of devices that are currently communicating. The RTT
is computed using Equ 4.
CRT T i = TP REQ + TP RES
where TP REQ is defined as the time needed for a particular
P REQ message to reach its intended destination module
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5
successfully and TP RES is the time for the proper acknowl-
edgment message. Both TP REQ and TP RES metrics are used
by legitimate devices Ci and server module Sj to separate
responses of numerous malicious devices Ak . In scenarios
where either the PREQ or PREP message of the requesting
device Ci is lost, the communication session is needed to be
re-initiated using a similar procedure as described above.
Theorem-2: A server module Sj will process a request iff
the request is authentic, i.e., requesting device Ci is authentic.
Proof: Suppose the PREQ message of device Ci is an authentic
request, is intercepted by an intruder Ak . The Ak is deployed
in the vicinity of the source device Ci and the concerned
server Sj . Furthermore, suppose Ak pretended as then con-
cerned server Sj . In that case, Ak is bounded to generate an
acknowledgment message, RREQ in this case, and send it to
the requesting device Ci . However, the requesting device Ci
will identify it as a malicious packet as this message will not
be received within the defined time interval. A back-off time
CRT T i , which Ci stored during the offline phase. Due to the
limited processing capability of these devices, it is tough for
an intruder device Ak to pretend itself as the concerned server.
If somehow Ak generates a similar response, but it will rarely
be able to send this response within the defined stipulated time
interval that is CRT T i in this case. Additionally, if the response
from a particular device Ci is intercepted by Ak and forward
a modified version to the intended server Sj . The concerned
Sj will reject it as it will be delivered within the defined time
frame due to the unusual transmission delay. Conversely, if the
request of authenticity (PREQ) of device Ci is processed by
server Sj then acknowledgment packet(PRES) will be received
by the requesting device Ci within the defined time interval,
i.e., CRT T i .
Hence, a legitimate server module Sj can process the authen-
tication request of Ci .
Additionally, the proposed dynamic mutual authentication
scheme bound every operational device Ci and server Sj
to use a 48-bits MAC addressing scheme for registration.
The registration process is performed in the offline phase as
described above. The MAC address of every device is listed
with every server Sj . Therefore, the probability that an intruder
device Ak will bypass this is negligible. It is because both
server Sj and Ci confirm the authenticity of the requesting
devices before permitting it to start a good communication
session. Furthermore, if a device Ci moves from the domain of
one server Sj to another server S − j + 1, then its authenticity
is re-checked by the concerned server, i.e., S − j + 1 in this
case. Lastly, suppose a requesting device Ci is identified as
an adversary device. In that case, it is added to the blacklist
class, and neighboring devices Ci are information about it.
As described above, both the requesting device Ci and server
modules Sj are bounded to transmit encrypted versions of their
messages to ensure secure and reliable communication sessions.
(4) For this purpose, the ECDDHP encryption scheme is used by
both source and destination modules in the proposed mutual
authentication scheme for the IoMT.
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Things Journal
IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021 6

Algorithm 1 Proposed Dynamic Mutual Authentication Algo- have a defined time interval during which successful delivery
rithm for Internet of Medical Things of the message is expected that is defined in the offline phase.
Require: Device Ci Request to establish a Communication (v) The proposed device authenticity mechanism is prone
Session against perfect forward, and backward secrecy attacks as the
Ensure: Permission Granted or Denied (Blacklisted) successful forwarding probability of the intruder device Ak
1: ClassReg ← Zero (to the concerned device and server) is significantly less. A
2: ClassM em ← Zero comprehensive analysis of the proposed device authenticity and
3: M sgenc ← ”null” existing models (concerning various possible intruder attacks)
4: ClassBlacklist ← Zero is presented in Table I.
5: Ci ← Devices in IoMT
6: Sj ← Server or Sinks in IoMT V. S IMULATION R ESULTS AND E VALUATION OF THE
7: for every Ci ∈ IoM T do P ERFORMANCE
8: Send M sgenc to Server Sj
9: if MAC (Ci ∈ ClassReg &ClassM em ) then In this section, a brief description of numerous performance
10: Ci is an authentic device metrics is presented to evaluate the performance of the pro-
11: Permit to initiate a communication session posed mutual authentication and field-proven algorithms using
12: elseif MAC address (Ci ∈ ClassReg ∈ / ClassM em ) different IoMT. For this purpose, these algorithms were imple-
then mented in OMNET++ using similar topological infrastructures
13: Ci is an authentic device i.e., same (i) number of devices Ci (ii) server(s) Sj and
14: Add Ci to ClassM em (iii) intruder device(s) Ak . These algorithms were evaluated
15: Permit to initiate a communication session extensively in terms of various performance metrics in the
16: elseif MAC address (Ci ∈ / ClassReg ∈/ ClassM em ) operational IoMT environment, such as communication cost,
then processing cost, average throughput, APDR, average end-to-
17: Ci is an intruder device end delay. At the start, random topologies with embedded
18: return Ci as intruder device delay (transmission and propagation) are used to mimic the
19: Ci is aided to class ClassBlacklist actual deployment process of the IoMT. Additionally, path loss
20: end-if ratio, propagation delay, and neighboring device interference
21: end-for are assumed to be constant in the operational IoMT as metrics
22: return Authentic and BlackListed Devices are beyond the proposed scheme scope. Numerous parameters
which are used in the simulation setup are presented in Table
II. To comply with the real deployment of the IoMT, standard
IV. S ECURITY A NALYSIS battery powers are used, such as Libelium Corporation.

In this section, a comprehensive analysis of various attacks

is performed. Also, possible attacks on the IoMT networking
infrastructure and how the proposed scheme is guaranteed to be
resilient against various attacks are presented. Furthermore, it
is to be noted that these attacks may occur at different levels in
the IoMT networks, i.e., devices Ci level and server Sj level.
(i) The proposed device authentication model is prune against
the client impersonation attacks. It is tough for an intruder
device Ak to pretend as a legitimate device Ci . Looking
to the limited capacities of these devices, decryption of the
intercepted message is far beyond the operational capacities
of these devices Ak in the IoMT. (ii) Device Impersonation
Attack is not applicable in the proposed authenticity model.
Every device Ci should be connected (member) with the nearest
server module Sj . Therefore, if an Ak attempts to pretend
itself a legitimate and registered device, the transmission of
messages must be intact to that of a compromised device Ci ,
which is not possible as long as Ak is a powerful device. (iii)
Server Impersonation Attack is possible only if an intruder
device Ak mimics the operational capabilities of the concerned
server Sj . If we assume that somehow Ak managed to mimic
itself as a server, but still excessive delay in its transmitted
messages will lead to an actual identity, i.e., intruder device
Ak in this case. (iv) The proposed scheme is not vulnerable to
eavesdropping attacks as every message is transmitted in the
encrypted. Moreover, both server Sj and member devices Ci
A. Computational Cost
Computational and communication costs are considered the
backbone of assessment criteria used to evaluate the newly
developed schemes’ applicability, particularly in secure IoMT.
A newly developed authentication scheme with the minimum
possible computational cost is considered an ideal solution.
Usually, it is preferred over a computationally expensive
scheme provided that it does not compromise on any of the
security measures. In this regard, a detailed and comparative
analysis (in terms of computational cost) of the proposed mu-
tual authentication scheme with existing schemes is presented
in Table III. In this table, Th is used to represent the time
needed to compute the hash function, and TXOR represents the
number of exclusive OR operations needed. Likewise, variable
Tran is used to describe random nonce. However, unlike the
traditional hash function(s), its computational cost is negligible.
A blank entry (empty slot) is used to depict a situation(s) where
a scheme does not use it, i.e., in Vaidya. et al. authentication of
sensor node or device is not needed. Therefore, it is represented
with ”-” as shown in Table III. In Table IV, the proposed mutual
authentication scheme’s computational cost is less than existing
schemes. Moreover, these costs are computed in the presence of
numerous intruder devices Ak , and it shows that the proposed
scheme is an ideal solution for the constraint-oriented IoMT
networks.

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Things Journal
IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021 7

TABLE I: Comparative Analysis of Various Authentication Schemes

Security Measure [19] [27] [18] [28] [17] Proposed Sch

Client Impersonate Attack X X X X × X
Member Device Impersonate Attack X X X X × X
Edge or Server Impersonate Attack × X × X X X
Eavesdropping Attack × × X X × X
Perfect Backward & Forward Attack X × X X X X
Man-in the Middle Attack X × × X × X

TABLE II: Internet of Medical Things Simulation Conditions

AODV-Algo
EAODV Mtr-Algo
Parameters values EAODV-Algo
IoMT Deployment Area 500m * 500m 60 EAOMDV-Algo
Devices Ci 50, 100 Proposed-Algo
Server or Sink Sj One

End-to-End Delay (micro sec)

Initial on-board Battery Power (Ei ) 52000 mAh 50
Residual Energy (Er ) Ei -Econ
Power Consumption to Transmit a Packet (PTx ) 91.4 mW
Transmission-Delay (Chdelay ) 10 milliseconds
40
Power Consumption to Receive a Packet (PRx ) 59.1 mW
Idle Mode Power Consumption 1.27 mW
Transceiver Energy (Ti ) 1 mW
Transmission Range (Tr ) 450m 30
Round Trip Time (RT Tn ) 4 msec
Packet Size (Psize ) 128 bytes
Hop Count (Hc ) of Server Sj 0 20
Hop Count (Hc ) of Device Ci 1
Device Ci Sampling Rate 10 seconds
Topologies Static and Random 10
Intruder Devices Ak 5 50 100 150 200 250 300
Traffic Type CBR and UDP Devices in the Internet of Medical Things
Attack Type Black-Hole

Fig. 4: Comparative Analysis of End-to-End Delay

B. Communication Cost
Communication cost has a direct proportionality factor to collected in the environment of IoMT, where numerous mali-
the average number of messages transmitted between the cious devices Ak were introduced in the operational networks.
source and destination devices, whereas these devices should
be authentic. For this purpose, we have considered only those
messages, both in offline (if any) and on-line phases, without D. Average Throughput
which a proper communication session between a device Ci
The average throughput of the IoMT is considered a vi-
and server Sj is at risk in the operational IoMT network. A
tal factor to evaluate the performance of the communication
comparative analysis of the proposed and existing scheme in
or routing approach, specifically if devices Ci are deployed
terms of communication cost is presented in Table IV, which
randomly. Furthermore, average throughput directly correlates
depicts that the proposed scheme has minimum communication
to the average packet re-transmission ratio, i.e., maximum
overhead. In some cases, the proposed scheme has higher
average throughput means minimum packet loss. Therefore, the
communication costs, i.e., [18], [28]. However, these schemes
proposed mutual authentication and communication scheme is
are computationally expensive as shown in Table III.
designed to easily attain maximum average throughput irrespec-
tive of IoMT deployment. The simulation result presented in
C. End to End Delay Figure.5 shows that the proposed scheme performs better than
the existing approaches in terms of average through evaluation
Generally, a communication scheme with the minimum pos-
metric. Furthermore, these measures were calculated for the
sible average end-to-end delay performance metric is assumed
IoMT, where numerous malicious devices Ak were introduced
to be an ideal solution to the problem in various realistic
and were trying to interfere. Apart from it, the scalability of the
environments of IoMT. Therefore, the proposed mutual authen-
underlined IoMT does not affect the exceptional performance
tication and communication approach is designed to ensure
of the proposed scheme, particularly in terms of average
minimum possible end-to-end transmission of packet(s) from
throughput.
source device Ci to destination Sj . It is evident from Figure 4
that the proposed scheme has achieved the minimum possible
delay metric against its rival schemes. During the simulation, E. Average Packet Delivery Ratio (APDR)
it is evident that end-to-end delay is highly affected if an The APDR is defined as the ratio of generated packets to
authentication scheme is vulnerable to various possible attacks, packets received successfully by the destination device Sj in the
a black-hole attack in this case. Furthermore, these results were operational environment of the IoMT. Likewise, a scheme with

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Things Journal
IEEE INTERNET OF THINGS JOURNAL VOL. XX, NO. XX, 2021 8

TABLE III: Comparison in terms of Algorithm’s Computational Cost

Scheme User/Client Device Ci Server Side Sj Total Cost

Proposed scheme (Mobile Devices) 2Th - 2Th + 6TRAN 4Th + 6TRAN
Gupta. et al. [28] 7Th + 4TXOR 4Th + 4TXOR 5Th + 3TXOR 16Th + 11TXOR
Abdelshafy. et al. [17] 5Th + 5TXOR 2Th + 1TXOR 2Th + 6TXOR 6th + 11TXOR
Makhalouf. et al. [18] - 2Th + 6TXOR 7Th + 7TXOR 9Th + 13TXOR
Liu. et al. [19] - 2Th + 2TXOR 1Th + 2TXOR 3Th + 4TXOR
Hasan. et al. [27] 2Th + 6TXOR 2Th + 5TXOR 3Th + 3TXOR 7Th + 14TXOR

TABLE IV: Comparative Analysis of the Communication Cost

AODV-Algo
Scheme Number of Messages Number of Bits EAODV Mtr-Algo
Proposed Scheme(Mobile Devices Ci ) 8 8,192 98.4 EAODV-Algo
Liu. [19] 60 30,620 97.6 EAOMDV-Algo
96.8 Proposed-Algo
Abdelshafy. [17] 5 24,546

Average Packet Delivery Ratio (%)

Gupta. [28] 5 3,038 96.0
Hasan. [27] 6 32,000 95.2
Makhalouf. [18] 5 6,144 94.4
93.6
92.8
92.0
91.2
90.4
AODV-Algo
40000 89.6
EAOMDV-Algo
88.8
EAODV-Algo
EAODV Mtr-Algo 88.0
35000
Proposed-Algo 87.2
86.4
30000
Average Throuput

50 100 150 200 250 300

Devices in the Internet of Medical Things
25000

20000 Fig. 6: Comparative Analysis of Average Packet Delivery Ratio

15000

IoMT is not operational yet. In phase-II (authentication), the

10000
100 150 200 250
Devices in the Internet of Medical Things
Fig. 5: Comparative Analysis Average Throughput
maximum APDR is preferred. It indicates the minimum packet
loss ratio and re-transmission of packets in the IoMT. The
proposed scheme has achieved maximum possible APDR than
its rival scheme, depicted in Figure 6. Additionally, these results
were computed in the realistic environments of IoMT, where the
possibility of numerous malicious devices Ak was maximum.
However, as the proposed scheme is prone to these attacks, the
proposed scheme’s performance is not compromised.
VI. C ONCLUSION AND F UTURE W ORK
In this paper, a lightweight mutual authentication scheme
is developed that ensures numerous communication sessions
between a member device Ci and server Sj in the operational
environment of IoMT. The proposed approach utilizes the MAC
and EAODV-enabled approaches to form a robust authentica-
tion scheme divided into three phases. In phase-I (offline), every
device Ci is bounded to register with the nearest server module
Sj . Therefore, as this phase is offline, the probability that an
intruder device Ak will be registered is zero as the underlined
formation of various communication sessions of Ci with Sj
300
is bounded to the device’s mutual authenticity. The server Sj
confirms the authenticity of the source device if the MAC of
Ci is available with Sj . Then it is a legitimate device that is
allowed in Phase-III to start a communication with the intended
server. Additionally, every message is encrypted to safeguard
its contents from potential intruders. Simulation results have
shown that the proposed mechanism is an ideal solution for
IoMT than existing schemes considering its convincing pro-
cessing and communication overheads.
ACKNOWLEDGMENT
This research is supported by Taif University Researchers
Supporting Project number (TURSP-2020/126), Taif Univer-
sity, Taif, Saudi Arabia.
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Things Journal
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