Healthcare Internet of Things Security Threats Challenges and Future Research Directions

This article has been accepted for publication in IEEE Internet of Things Journal.
This is the author's version which has not been fully edited and
content may change prior to final publication. Citation information: DOI 10.1109/JIOT.2024.3360289
Healthcare Internet of Things: Security Threats,

Challenges and Future Research Directions
Muhammad Adil, Member, IEEE, Muhammad Khurram Khan, Senior Member, IEEE, Neeraaj Kumar, Senior
Member, IEEE , Muhammad Attique Member, IEEE, Ahmed Farouk, Senior Member, IEEE, Mohsen
Guizani, Fellow, IEEE, Zhanpeng Jin, Senior Member, IEEE
Abstract—Internet of Things (IoT) applications are switching I. I NTRODUCTION

from general to precise in different industries, e.g., healthcare,
automation, military, maritime, smart cities, transportation, lo-
gistics, and many more. In the healthcare domain, these appli- Healthcare Internet of Things (HC-IoT) applications are the
cations had demonstrated an incredible improvement in patient inherited version of the IoT technology, in which numerous
assessment, monitoring, and prescription, etc., with ease of access patient wearable devices, IoT devices, and other networking
through the Internet. Despite its benefits, this technology also components are coupled in the network topological order to
offers several security challenges for the research community and collect, process, and transmit data [1]. The popularity of this
healthcare stakeholders, because of its wireless communication
and open-area deployment. To explore, patient wearable devices emerging technology progressively increasing, because of the
and other networking entities follows unstructured communica- simple use, cheap market price, and productive results [2].
tion format to share their accumulated data in the network, which This technology has numerous advantages over the traditional
makes them susceptible to manifold security threats. Considering technologies in terms of productivity, but at the same time, it
the significance of these applications, data acquisition, processing, has some disadvantages in the context of security concerns.
storage, and assessment on client and remote sides need a high
standard of secure communication infrastructure. Therefore, This depreciate its extensive use in many applications and
security of these applications is one of the major obstacles that particularly in the healthcare domain [3]. Despite this, we
prevent their widespread use in different healthcare domains. To also know that patients wearable devices are usually deployed
discuss different security constraints, in this paper, we present a in an unstructured manner, which follows wireless commu-
comprehensive survey of the theoretical literature from 2015- nications to send data from a source to a destination node
to-2023 to highlight the unresolved security problems of this
emerging technology. Based on the evaluated literature pros and [4], [5]. Open area deployment and wireless communication
cons, we determine the security requirements and challenges make these devices exposed to multiple intrinsic and extrinsic
of Healthcare-IoT (HC-IoT) applications. Following this, we threats during the operational environment. Taking advan-
demonstrate future research directions that could be useful tage of this, an attacker can easily launch destructive cyber-
for the researchers and industry stakeholders working in this attacks, such as Eavesdropping attacks, Client Impersonation
domain. To demonstrate the uniqueness of this work and claim its
contribution, we compare our work section-wise with previously attacks, Distributed Denial of Service attacks (DDoS), Base
published papers to answer the question of reviewers, editors, Station attacks, Server Side attacks, Jamming attacks, Black-
students, and readers, why this review article is required in the hole attacks, Anonymity attacks, Sybil attacks, and Wormhole
presence of already published review articles. attacks, etc., to hijack the security of the HC-IoT application
Index Terms—Cybersecurity, Healthcare Internet of Things, [6], [7].
Security Challenges, Cryptographic techniques, device-to-devices
To explore, recently, traditional IoT applications have been
authentication, secure communication infrastructure.
targeted through the aforementioned attacks to extract legit-
imate user information or disrupt legal network operations.
With such possibilities and progressive growth, these applica-
M. Adil is with the Department of Computer Science and En- tions in the healthcare domain require reliable authentication,
gineering, University at Buffalo, NY 14260, USA. E-mail: (muham- validation and verification schemes to maintain the trust of
mad.adil@ieee.org/madil2@buffalo.edu)
Muhammad Khurram Khan is with the Center of Excellence in Information
patients, healthcare staff, and corporation market stakeholders
Assurance, King Saud University, Riyadh, Saudi Arabia (e-mail: mkhur- [8], [9]. To assess the most recently used authentication and
ram@ksu.edu.sa) data preservation techniques in HC-IoT applications with their
Neeraaj Kumar is the with Thapar Institute of Engineering and Technology,
Patiala Punjab India. (e-mail: nehra04@gmail.com/neeraj.kumar@thapar.edu)
privileges and impediments, we provide a thorough review in
Muhammad Attique is with the Department of Software, Sejong University, this paper.
Seoul 05006, Korea (e-mail:attique@sejong.ac.kr) The primary contributions of this work are summarized as
Ahmed Farouk is with the Department of Computer Science, Faculty of
Computers and Artificial Intelligence, South Valley University, Hurghada below:
83523, Egypt (e-mail: ahmed.farouk@sci.svu.edu.eg)
Mohsen Guizani is with the Mohammad Bin Zayed University of Artificial 1) To begin, firstly, we discuss existing review articles on
Intelligence, Abu Dhabi, UAE (e-mail : mguizani@ieee.org) this topic to highlight their contributions and limitations.
Zhanpeng Jin is with the School of Future Technology, South China Based on this, we will set a foundation for our survey
University of Technology, Guangzhou 511442, China, and the Department
of Computer Science and Engineering, University at Buffalo, Buffalo, NY article to address the problems that have been ignored
14260, USA. (e-mail: zjin@scut.edu.cn) in these articles.
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This article has been accepted for publication in IEEE Internet of Things Journal. This is the author's version which has not been fully edited and
2) Thereafter, we familiarize the readers with this emerging A. Primary questions that would be addressed in this survey
technology by demonstrating how the era of HC-IoT ap- article
plications has been evolved swiftly over the last couple The ultimate focus of this survey paper is to familiarize the
of years. Consequently, we underlined the importance readers, researchers, students, and industry stakeholders with
of security in these applications to set a preface for the the limitations of the existing literature associated with the
consequent sections. security concerns of HC-IoT applications. Despite this, we
3) Next, we discuss the existing literature associated with would like to enable them to better understand the security
the authentication and data preservation of HC-IoT ap- requirements and challenges of these applications followed by
plications to identify and classify their advantages and open challenges with potential research direction. To keep this
disadvantages. Based on this, we evaluate the specific discussion concise and concrete, we will go through the year-
literature to fill the limitations gap of present studies. wise publications by searching the most famous databases to
4) Despite this, we conduct the statistical analysis of de- know how many countries contributed to this field in the recent
mographic research contributions continent-wise from past.
2014-2023 to know the current progress throughout the Given the mentioned facts, we can frame the question of
globe, and to acknowledge the importance of this topic this study’s as follows:
to attract the attention of researchers and readers.
1) What are the key factors and requirements that must
5) Consequently, we underline the open security chal-
be cosidered while designing authentication and data
lenges of HC-IoT applications by taking into account
privacy schemes for HC-IoT applications?
the present literature limitations to set a preprint for
2) Enlist the most contemporary research that was con-
future research. Finally, we claim the distinctiveness and
ducted recently to counter different security threats of
novelty of this review article by comparing each section
the HC-IoT applications (continent-wise work).
with the popular review articles published on this topic.
3) How has research on HC-IoT applications security
The rest of the paper is organized as follows: In the evolved over the years across various publication
introduction section, we will examine the common distinction venues?
between IoT and HC-IoT. Likewise Section II briefly describes 4) How does this paper differ from existing papers in each
the comparative survey papers accompanied by the motivation section-wise comparison?
and research questions of this work. Consequently, Section III Responding to these points will nurse to gain a deeper
evaluates the present literature associated with the authenti- understanding of the existing HC-IoT application’s security
cation and data preservation of HC-IoT applications, whereas concerns to recognize substantive research possibilities corre-
the security requirements noticed during the review process lated with these applications.
are highlighted in Section IV. Section V demonstrates that how
this paper is different from the existing review articles in terms III. R ESEARCH S TRATEGY, Q UESTIONS , AND HC-I OT
of quantitative analysis. Section VI contains the information S ECURITY R EQUIREMENTS
regarding future research by describing the role of different
In this section, we will incorporate the research strategies
cryptographic techniques, routing protocols, fog computing,
that are used precisely in this work to overview the existing
blockchain, machine learning, and edge computing, etc, that
literature related to security requirements and challenges of the
could be productive for secure HC-IoT networks. Section VII
HC-IoT applications. For this, we have searched the databases
eventually summarizes and concludes the paper (Flowchart
such as IEEE Xplore, Google Scholar, PubMed, Education Re-
Diagram 1).
sources Information Center, ACM Library, and ScienceDirect,
etc., [21]. Despite that, we classified the search review into
two parts. In the 1st part, we have searched the databases for
II. R ELATED R EVIEW A RTICLES the papers having titles related to HC-IoT in general to take
a broad overview of the existing literature. In the 2nd part,
In literature, there exist numerous studies related to HC- we have narrowed our search to the security requirements and
IoT applications security. Here in this section, we concisely challenges of HC-IoT applications by removing articles that
resembled some up-to-date surveys to know their contributions do not include the term ”security” in their abstract and title.
and limitations to set a preface for our article contribution. A brief sketch of the articles searched for this work is
Likewise, based on identified limitations of the present studies, illustrated in Fig 2. To summarize Fig 2, we have searched the
we will add relevant literature in this article to highlight open aforementioned databases and detected approximately 12563
research challenges and demonstrate future research directions articles, which were later reduced to 1830 articles. Thereafter,
in this domain. In TABLE I, we have summarized the existing we have narrowed down our search to select those papers, they
state-of-the-art survey articles in the context of their contribu- have the word security in the title and abstract, and found
tions and limitations to set a stage for our contribution. approximately 650 papers. Next, we removed the duplicate
In the upcoming sections, we will address the limitations paper, which minimized the total strength to 415. In the next
of the existing state-of-the-art review articles to exhibit the phase, we have checked the complete text of the remaining pa-
uniqueness of this work and argue why this paper is necessary pers to emphasize on relevant papers. After a brief evaluation,
in their presence. the total remaining papers were 305. Consequently, we have
TABLE I: Summary of existing review articles with their contributions and limitations
References Contribution Limitations Our Redressal
Meneghello
et al. [10] • Surveyed the current literature • Superficial examination of security • Discussed layer-wise security threats
(2019) • Outlined general security vulnerabili- concerns • Provided a concrete background knowl-
ties • Lack of discussion on literature for edge
• Only focused on network and session physical layer, data link layer, and • Highlighted open security challenges
layers application layer • Suggested possible research directions
• Lack of in-depth Analysis
Qadri et al.
[11] (2020) • Thorough review of HC-IoT applica- • It was a balanced review • Comprehensively discussed the require-
tions • Lack of a solid overview of security ments of HC-IoT
• Highlighted security problems of HC- problems • Brief overview of present literature
IoT • Lack of potential research directions • Highlighted open security challenges
• Potential impact on technology use • Suggested possible research directions
Bhuiyan
et al. [12] • Over-viewed security threats • Absence of limitations of existing lit- • Comprehensively discussed layer-wise
(2021) • Evaluated some countermeasure erature security threats
schemes • Suggested solutions without concrete • Highlighted the limitations of current
• Underlined the requirements of this discussion literature
technology • Incomplete portrayal of open security • Underlined open security challenges
challenges • Suggested possible research directions
Alshehri
et al. [13] • Reviewed Literature (2014-2019) • Did not highlight the limitations of AI • Covered all relevant literature
(2020) • Talked about AI-enabled countermea- • Have not highlighted the vulnerabili- • Familiarized readers with requirements
sures ties of internal employees of this technology
• Focused on data security • Underlined open security challenges
• Suggested possible research directions
Zikria et al.
[14] (2021) • Discussed enabling technologies • Absence of a literature preface • Comprehensively talked about different
• Talked about general security • Only talked about future challenges security threats
• Highlighted future security challenges instead of solutions • Covered relevant literature
• Lack of technical detail • Highlighted open security challenges
• Discussed future research directions
Raghuvanshi
et al. [15] • Talked about the authentication re- • Omission of physical, network, and • Covered various security problems
(2022) quirements application layer security threats • Talked about interoperability literature
• Discussed the importance of data pri- • Haven’t talked about interoperability • Highlighted open research challenges
vacy security challenges • Underlined possible research directions
• Talked about different security flaws • Haven’t focused on scalability and in
• Discussed authentication schemes problems
Somasundaram
et al. [16] • Comprehensive discussion of security • Some latest security threats are ig- • Latest literature is comprehensively
(2021) requirements nored covered
• Talked about physical and data link • Open security is overlooked • All security Requriements
layer security threats • Data privacy challenges are missed • Expected open challenges
• Highlighted limitations in the current • Possible research directions
literature
Butpheng
et al. [17] • Thoroughly surveyed literature (2017- • Hardware security challenges are • Comprehensively discussed the interop-
(2020) 2020) missed erability security challenges
• Main focus was on security chal- • Open security challenges are over- • Highlighted problems of integration
lenges during integration looked by keeping all aspects • Acknowledged the importance of rout-
• Software-related problems are tar- • Routing hasn’t been discussed ing protocols
geted
Li et al. [18]
(2021) • Discussed different security threats • Haven’t highlighted the limitations of • Covered attacks with relevant literature
comprehensively current literature • Talked about ML-based algorithms’
• Only focused on ML-based counter- • Overlooked device-to-device authen- problems
action schemes tication • Highlighted open challenges with ML-
• Mostly talked about data privacy • Ignored the computation complexity based security techniques
issues
References
[19], [20] • Talked about edge-side security • Haven’t discuss network security • To ensure the uniqueness of our work,
(2019, 2021) • Covered literature related to edge de- problems we have included potential research
vice authentication • Haven’t discuss application layer directions based on underlined chal-
• Physical layer security problems lenges.
• Future research directions were ig-
nored
Paper Structure
Introduction
Contributions Paper Related Review Articles Conclusion

organization
Research Papers
Questions
evaluation
Research Strategy and HC-IoT Security Open Challenges and Future Research
Requirements Directions
Decentralized Cost-effective
Access control Confidentiality, Security Attack Authentication Challenges Authentication
Integrity, authentication maintainability Resilience
Secure key Secure multi-factor User’s Interopera

Decentralized
Distribution Authentication
Certificate Attestation authentication awareness bility
distribution
Secure Handover of Secure data Storage

Secure Integration Mobile Authentication Secure Communication
user’s during mobility
Fig. 1: Paper organization flowchart
Start searching the below

databases for HC-IoT
papers (12563)
Narrow our search to

Starting
point
Finally evaluated HC-IoT security

papers of HC-IoT security (1830)
(243)
Papers they have the

word HC-IoT security in
scrutinize of relevant title & abstract (650)
security papers
IEEE Xplore, Google Scholar ACM

Digital Library, PubMed, ScienceDirect
Full text regarding After removing

HC-IoT security duplicated papers
(305) (415)
Fig. 2: Publications statistical analysis of different databases to identify concrete relevant literature
filtered these papers once more, and finalized 243 articles for A. Primary Security Requirements of HC-IoT (Question 1)
this exclusive survey to answer the highlighted questions.
In this segment, we discuss the security requirements and
specifications of the HC-IoT applications. Furthermore, we
will incorporate a brief explanation of these requirements
Flash: Notably, our approach does not exhibit the Matthew and challenges to answer the question, why these criteria are
model [22], such as citation, when retrieving articles from thought to be important. With this, we will extend our discus-
suggested databases. sion to know why certain standards are contrary to meeting
the security requirements, challenges, and specifications of applications. Craggs et al. [119], continued this discussion
these applications. Following these factors would be assumed and present a review paper by focusing on the security of
a sense of motivation for this work. digital healthcare to outline and define a reference model
In [23]–[26], the authors discussed manifold HC-IoT appli- for the security requirements of these networks. Reference
cations in the context of different security requirements. Fur- [120], suggests a security approach for a supply-chain IoT
thermore, they acknowledged the scenario-based importance network. In this paper, the writers highlighted the penetration
of these applications with different threat models to present spaces in the supply chain network, which were later on
concrete evidence of the present literature. To keep the security considered as a security liability of the employed network.
requirements and challenges in a well-structured format, we McGinthy and Michaels [121] proposed a secure architectural
have grouped them according to the circumstances. This gives model for the HC-IoT networks. In this model, the authors
us a path to address them with respect to the defined format grouped architectural skeletons into different energy classes
and flow control. to manage security concerns of employed devices in terms
In TABLE II, we have summarized different security re- of confidentiality, authenticity, integrity, and access control
quirements of HC-IoT applications with their concerned liter- mechanism. Becue et al. [122] continued this discussion and
ature. suggested that there is a must-need situation to intensify the
avoidance, interruption, interference, and response to adver-
B. General security Requirements sary attacks in HC-IoT networks with the help of machine
In this subsection, we revisit the literature to delve into learning algorithms. Likewise, Dhillon et al. [123] worked on
the security requirements of HC-IoT applications with the the security problems of HC-IoT networks, and determined the
objective aiming to understand the limitations of existing expected architectural security vulnerabilities that can hamper
studies. In conjunction with this, we discuss relevant authen- the operation of these applications.
tication and data privacy schemes to highlight the research Tange et al. [124] explained the susceptibility and security
gaps. Additionally, we provide recommendations and spotlight concerns interlinked with HC-IoT networks by assuming dif-
specific literature that can enhance the security of HC-IoT ferent operational aspects of interconnected devices in the net-
applications. work. In [125], the authors described different security risks of
Eckhart et al. [116] analyzed different security threats of HC-IoT applications that had been noted in the existing litera-
digital healthcare with the help of multiple threat models to ture. Reference [126] continued this discussion to highlight the
demonstrate that what are the data preservation requirements security risk that would be unavoidable without an adequate
of digital healthcare that must be addressed at various phases risk evaluation method. Furthermore, the authors highlighted
to achieve optimal results. Despite this, the authors of this that most of the existing application uses traditional risk
article highlighted fourteen security obligations that must be management approaches which are not proficient to resolve the
considered during the network deployment phase. Maksuti security problems of IoT applications. In [127], Mouratidis and
et al. [117] used an intelligent data analysis framework to Diamantopoulu proposed a systematic data analysis framework
assess the overall system’s effectiveness of HC-IoT appli- for the HC-IoT network to detect anomalies in real time
cations in terms of security by investigating the correlation networks. In this scheme, the authors developed a Secure
between system security and business processes. With this Tropos Language model to detect anomalies during the data
technique, the authors suggested and acknowledge that we evaluation phase. Boyes et al. [128] suggested a manual
can use a self-adapting system for these applications that approach by utilizing a multidimensional paradigm for risk
could be capable of providing end-to-end security during analysis to detect and prevent malicious device interference
transmission. To simplify the given technique, the authors in the networks. To address these concerns, Lvkic et al. [129]
assumed the following scenario as an example. Let’s assume designed an onion layer intelligent model to detect and prevent
that, the Transport Layer Security (TLS) protocol events or such kinds of attacks in HC-IoT applications.
sessions during the communication process, which can be
recycled to support sporadic messages whereby the intim-
C. Data Confidentiality, Integrity, and Availability in HC IoT
idation is considered to be weak. In this case, the TLS
applications
could be customized according to the threat level on the fly
to accommodate these situations with respect to TLS hand In any wired or wireless network, confidentiality, integrity,
shacking and a congestion-free traffic environment. In [40] and availability (CIA) of information are treated as a grouped
the authors discussed several security challenges associated of prerequisite for data privacy and preservation [130]. Sub-
with blockchain-enabled healthcare IoT applications. Despite classes of these security needs are interlinked with each other
this, they also discussed different countermeasure schemes that to manage a full package for an operational network. Fig 3,
had been used to counter the highlighted challenges. In this of the paper, presents a sketch overview of these subgroups
article, the authors mentioned that it is always extra effective to accompanied by demonstrating examples and solutions.
reveal more customized systems rather than using generalized Consequently, we are going to describe the CIA require-
systems, methods, and algorithms to counter different security ments individually by following reference [131].
threats of digital healthcare. 1) Confidentiality commits to the state of retaining or
In [118], the authors presented a combined security model holding the information secret when it comes to data
of IoT applications that had been used in mobile healthcare sharing in networks, organizations, or institutions. Fol-
TABLE II: Security requirements of HC-IoT applications (Question 1)

Network security & method- Confidentiality, integrity, & Security maintainability & mon- Resilience & access control
ologies availability itoring
Graham et al. [27], present In [29]–[32], the authors dis- Rana et al. [33], present an in- In [34], [35], a sensor-tag-based au-
a general review of the dif- cussed different security chal- telligent key distribution scheme thentication model for HC-IoT appli-
ferent security threats of HC- lenges such as CIA of HC- known as Bring Your Own Key cations was proposed to resolve the
IoT applications. While refer- IoT applications to familiar- (BYOK) to resolve the authenti- authentication problem in these net-
ence [28] extended this discus- ize the readers with their con- cation problems in HC-IoT appli- works utilizing Chebyshev Chaotic-
sion by presenting a thorough sequences. cations utilizing Near Field Com- Map-based single-user sign-in (S-
survey regarding the various se- munication (NFC) and dedicated USI) algorithm.
curity challenges of blockchain- secured hardware.
enabled HC-IoT applications.
In [36] the authors proposed References [37]–[48] com- Mishra et al. [49] suggested a Abawajy et al. [50], introduced
an advanced Hypertext Transfer prehensively discussed the se- Multi-Level Distributed Denial of an advanced cloud and Internet
Protocol (HTTP) in collabora- curity challenges and require- Service attacks (DDoS) mitigation of Things-based pervasive patient
tion with edge intelligence (EI) ments of HC-IoT applications architecture for IoT applications health management (PPHM) frame-
to address security concerns of in the context of data in- utilizing fog, edge, and cloud com- work for HC-IoT to fix the energy
HC IoT applications utilizing the tegrity, availability, authentic- puting architectures. efficiency and security problems.
traffic classification model. ity, and confidentiality.
In [51]–[55], the authors present References [56]–[59], address References [60]–[63] briefly out- In [64], the author discussed differ-
a comprehensive study related to the basic concepts of data pri- line the current security require- ent business models of HC-IoT ap-
the security threats of HC-IoT vacy in HC-IoT applications ments of HC-IoT applications by plications by taking into account the
applications by assuming their by defining the responsibili- taking into account the anomaly security guidelines of these networks
communication attributes to fa- ties of the General Data Pro- detection and prevention tech- in the design phase.
miliarize readers with different tection Regulation (GDPR) in niques.
countermeasure schemes. these networks.
A predictive data analysis (PDA) References [66]–[70] outline In [71]–[74], the authors reviewed Bicaku et al. [75], proposed a com-
technique was used by Tolba et different approaches that had the HC-IoT devices production ponent integrating strategy for HC-
al. [65], to counter different se- been used in the recent past line’s vulnerability threats. Further- IoT applications to resolve the au-
curity threats in HC-IoT appli- to guarantee the preservation, more, they familiarized the readers thentication problem in these net-
cations and ensure data integrity integrity, and privacy of data with the automatic production line works. This model was constituted
during transmission. flow in the HC-IoT applica- security check methods to ensure of components that were interopera-
tions. security of these devices in the ble to monitoring and assessing the
production phase. standard authentication process.
Moosavi et al. [76] suggested References [77]–[83], present References [84]–[88] proffers multi In [89], discussed different authen-
the session resumption method a brief background study of authentication models to resolve tication and data privacy techniques
to address the authentication is- the core components of HC- the data protection and vulnerabil- that how to secure large IoT appli-
sues in healthcare IoT networks IoT networks i.e. endpoint ity problems in the HC-IoT applications against various attacks.
without handshaking and certifi- devices. cations.
cate establishment.
Reference [90], exhibits a de- References [91]–[94] address Chen et al. [95], proposed a secure References [96]–[98], assess the se-
tailed survey of the current liter- the obstacles related to the Industrial Internet of Things (SecI- curity standardization landscape of
ature regarding the smart grid se- security of the HC-IoT net- IoT) framework for practical autho- the existing literature of HC-IoT net-
curity challenges based on deep works followed by suggested rization of IoT devices deployed in works.
packet inspection. solutions in terms of hard- the designated area.
ware or software components.
Tewari et al. [99] describe the References [100], [101] ad- Saeed et al. [102], proposed a L- Reference [103], examines the appli-
layer-wise security problems as- dresses the HC-IoT transport OOCLS (lightweight online/offline cability of the IEC 62443 standard in
sociated with IoT networks. layer problems, and offers certificate-less signature) based au- the connection of the IoT networks
some ideas for overcoming thentication model for HC-IoT net- to consider the potential obstacles
these limitations. works by utilizing the remote related to the security of these net-
anonymous authentication protocol works.
(RAAP).
References [104]–[107] Reference [108], [109], rep- The challenges associated with the In [115], the authors present a col-
discussed several vulnerability resent the security challenges structure, network topology, and lection of documents from the Eu-
threats of HC-IoT applications in associated with the robotics resource management of HC-IoT ropean Union Agency for Network
the context of present literature ecosystem, integrator, compa- applications are discussed in refer- and Information Security (ENISA)
such as countermeasure nies, and original equipment ences [110]–[114]. to highlight different security chal-
schemes. manufacturers (OEMs), etc. lenges of HC-IoT applications.
TABLE III: Comparative analysis of the security requirements of IoT and particularly HC-IoT with present review papers
(Question 1)
Comparative References Network security & Confidentiality, Integrity, Security Maintainability Resilience and access con-
Methodologies & Availability & monitoring trol
Meneghello et al. [10] Yes Partially Yes Yes No

Qadri et al. [11] No Partially Yes Yes No
Bhuiyan et al. [12] Yes No Yes Partially Yes
Alshehri et al. [13] Yes Yes Partially Yes No
Zakaria et al. [14] Partially Yes No No No
Raghuvans et al. [15] Partially Yes partial Yes No No
Somasundaram et al. [16] No Yes Partial Yes Partial Yes
Butpheng et al. [17] Partially Yes Yes No No
Our paper Yes Yes Yes Yes
Confidentiality, Integrity quirements of a system for the CIA triad if we have already
and Availability (CIA) reliable authentication and data preservation model, then it
would be sufficient for this to fulfill the security goal of
any IoT application and particularly HC-IoT applications. For
example, it is possible to specify a mechanism that will be
capable to keep data private regardless of whether it is in use or
CIA in not, but this does not guarantee that the suggested mechanism
1.Redundancy 1. Compression
2.Timeliness HC-IoT 2. Access Control will meet all the necessary requirements of the CIA. On the
3.Distribution 3.Encryption
4. Decryption other hand, high-quality standards are only attainable, if we
Data design a particular scheme for a special system or situation. In
Hashing
Integrity Error the follow-up sections, we will attempt to identify and explore
& in HC-IoT Detection
the background knowledge of the CIA’s security requirements
Authentic &
ation Correction in the HC-IoT applications at a high level. But at the same
time, we will be stick with our topic to identify the particular
Fig. 3: CIA detail evaluation with their individual part security security requirement of HC-IoT networks.
measure
D. Authentication of Legitimate Devices
lowing this, only authorized people will be allowed to Authentication of devices guarantees the legitimacy of de-
open or check this information. ployed entities, i.e. sensor devices, humans, robots, machines,
2) Integrity refers to the preservation of data in its original or even applications, and will be assumed the main con-
context, as well as continuity, accuracy, reliability, and cern of any network [136], [137]. Fixing these hurdles with
more broadly an entity’s overall trustworthiness. Gen- cryptographic techniques or routing protocols brings some
erally, it means keeping the information in its original supplementary challenges in the networks for administrators
form. and enterprise market stakeholders, which are explicitly dis-
3) Availability refers to the right of access to a system, cussed in references [15], [18], [30]. In order to address these
operating system, data or information. In addition, this challenges, extremely lightweight authentication schemes are
involves the issues of tautology and decentralization required to be developed that will have the least computation
followed by the strict deadlines of the projects to be and communication time, transmission size, and memory stor-
completed well in time. age requirements, etc. To continue this talk, Wang et al. [138]
In normal circumstances, the CIA triad is used to describe present a comprehensive survey related to various security
the relationship between information protection, network se- problems associated with the HC-IoT applications. In this arti-
curity, and data integrity. Similarly, this theory is very true cle, the authors are suggested possible research directions that
in other disciplines, such as cybernetics, IoT applications, could be useful while devising new authentication techniques
cyber-physical system, and many more [40]. To examine the and data preservation schemes for HC-IoT applications.
CIA triad comprehensively, we suggested the readers to went To investigate further, we considered the Message Queue
through references [132]–[135]. In industrial environments, Telemetry Transport (MQTT) protocol as an example, which
the emphasis of networks is traditionally on the availability, had been already used in industrial IoT networks for authenti-
integrity, and privacy of the data. With the introduction of cation. Although, at present, MQTT is the most used protocol
new Industrial IoT applications such as HC-IoT networks, for secure data transmission in the industrial sector, but, it
security and trustworthiness should be weighed equally on has numerous flaws in terms of unsafe authentication and
the availability and comparison of data. Therefore, CIA is to data privacy [139]. Katsikeas et al. [140] clarified the MQTT
be assumed as a valuable offset feature for any networking protocol a little more by explaining an authentication process
application while defining its security goals. through a basic username and password processes. In this
In contrast, it is not essential to overcome the basic re- model, the author’s assumed a scenario of MQTT validation,
whereas the user name and passwords are transmitted in plain Therefore, it is likely expected that such a huge amount of
text over a transmission medium that is always susceptible to authentication request will create communication overheard
external attacks. Furthermore, the authors explained that how and degrades network performance. Consequently, the author’s
we can make this protocol prone to an adversary attack by also talked about transitive authentication, where A verifies B,
adding complementing MQTT with the IP Security (IPSec) or and B introduces A to C in terms of authentication in the
Transport Layer Security (TLS) [141]. In [142], the authors network, which also leads to network overhead.
proposed a useful and appropriate authentication schemes and Reference [148], proposed a key management approach for
demonstrated its implementation in the Open Web Application HC-IoT networks that uses a single-way/unicast authentication
Security Project (OWASP). In this article, it is clearly visible process. Although, this was an energy-efficient model, but
that the IoT devices bugs lacks the proper authentication the proposed model is not for large-scale networks that have
process in various aspects, which need reliable authentication the scalability expectation. Despite that, in this model it was
models. mandatory for all IoT devices to be identified beforehand
For easy accessibility, we summarized all the references of by revocation and re-keying, which is not discussed compre-
different authentication schemes in TABLE IV. hensively and leaves this model in a fuzzy state. References
Likewise, we will extend our discussion to key sharing [149] proposed a distributed key authentication model, which
to familiarize the readers with the background of this topic. uses Distributed Hash Table (DHT) to resolve the authenticity
Thereafter, we will have to continue the same topic by adding problem in HC-IoT networks in a distributed environment
relevant literature of the key management and key validation rather than the centralized setting. This model was flexible,
accompanied by two, three, and multi-factor authentication but complicated in its structure to validate legitimate devices,
models. Despite this, we will examine non-repudiation as a which minimizes their use in real networks. To some extent,
prerequisite for authentication schemes preceded by passive the references listed above address the recognized problems of
verification, authentication, and data preservation algorithms. key management in the HC-IoT network but still leave open
Finally, we will talk about attestation approaches that had used research problems for the research community, which need
to ensure the trustworthiness of hardware and software in HC- to be resolved. Some potential solutions for key distribution
IoT applications. All of these suggested techniques are shown problems were identified in the direction of quantum cryp-
in TABLE IV with their references. tography [146]. With the use of quantum cryptography, the
1) Authentication through key distribution : communication cannot be eavesdropped without modifying the
payload, which indicates that any eavesdropping effort may
Key distribution in HC-IoT applications is a rigorous pro- be detected effectively in the network, before its operation.
cess because these applications are inherited or modified Therefore, the future of authentication schemes is expected to
versions of IoT devices [31], therefore, computation-efficient be tiddly coupled with quantum cryptography.
authentication schemes are needed for these networks. With 2) Mutual authentication schemes :
this relevancy, HC-IoT applications demand extremely secure
communication infrastructure with a salable network, and In this segment, we will talk about different authentication
effective key management and distribution systems [78]. In schemes such as mutual, two-factor, three-factor, and multi-
order to address this problem, Sahoo et al. [143], proposed factor. Reference [150], proposed an intelligent mutual authen-
a Conventional Public Key Infrastructure (PKI) authentication tication for the HC-IoT applications. In this article, the authors
model for HC-IoT applications. The objective of the proposed considered the actual conditions of realistic authentication
model was to improve the communication metrics of the circumstances of an operational network to evaluate different
healthcare employed network. This topic is further explored in communication metrics. Kolluru et al. [201] continued this
references [193]–[197] to familiarize the readers with different discussion, and proposed a Service-Oriented Architecture-
techniques and their ability that how to cope up with this Based (SOA) mutual authentication for the HC-IoT applica-
problem in operational HC-IoT applications. Furthermore, the tions by considering important aspects of networks i.e. device
authors discussed many inevitable criteria for key management identity and communication channel, etc. References [151],
that might be used in the future to accommodate the extension, [153]–[156] consequently realized the importance of auto-
elimination, and re-keying of interconnected devices. mated mutual authentication models for HC-IoT applications
As we know, resource-restricted devices experience prob- with fundamental security requirements. With this, they also
lems with key generation and matching, when the legitimate acknowledged that the use of clone-able functions could be
devices authentication model is complex, because of the com- a better option rather than using or defining other parameters
putationally intensive algorithms followed by a huge number for authentication in these networks.
of devices. To address this issue, the industry owners prefer Reference [157] demonstrated various context-aware au-
to use their own key management system rather than vendor- thentication frameworks that had been used as an alternative
created keys management systems for better security man- techniques for the authentication of legitimate devices in HC-
agement at the organization level [144], [145], [152], [198]– IoT applications. Likewise, a radio frequency-based fingerprint
[200]. In [147], the authors highlighted that one authentication authentication scheme was proposed in reference [158], which
authority is not sufficient for a heterogeneous HC-IoT network uses the transmission frequency of legitimate devices to ensure
in a critical infrastructure because the authentication authority their verification and validation in real time. In [159], a two-
has to entertain too many validation requests during operation. factor mutual authentication scheme leveraging smart cards
TABLE IV: Security requirements based on authentication followed by relative interest percentage (%) (Question 1)
Description of specific security require- Related work references Interest of security re-
ment quirement in percentage
Key distribution authentication schemes Han et al. [31], Xu et al. [32], Yang et al. [77], Rana et al. [33], Banupriya et With an overall (18% (rel-
used for HC-IoT networks al. [132], Mburano et al. [142], Sahoo et al. [143], Hou et al. [144], Katsikeas ative interest high))
et al. [145], Miao et al. [140]
Multi Factor Authentication schemes used Dhillon et al. [146], Roy et al. [147], Shamshad et al. [148], Ahmed et al. [149], With an overall (12% (rel-
for HC-IoT networks Dhillon et al. [146], Wu et al. [150], Fotouhi et al. [151], Kumar et al. [1] ative interest moderate))
Decentralized authentication and key man- Weippl et al. [136], Mohanta et al. [152], Roy et al. [147], Shamshad et al. With an overall (10% (rel-
agement schemes used for HC-IoT networks [148], Ahmed et al. [149], Dhillon et al. [146], Wu et al. [150] ative interest low))
Mutual authentication schemes used for Deebak et al. [34], Fotouhi et al. [151], Garg et al. [153], Singh et al. [154], With an overall (21% (rel-
HC-IoT networks Khemissa et al. [155], Al-Turjman et al. [156], Loske et al. [157], Tian et al. ative interest high))
[158], Hu et al. [159], Hussain et al. [160], Li et al. [161], Puri et al. [162],
Dantu et al. [163], Zhao et al. [164]
Data Preservation authentication schemes Guan et al. [165], Ma et al. [166], Fraile et al. [167], Ankele et al. [168], Zhang With an overall (17% (rel-
for HC-IoT networks et al. [169], Lizardo et al. [170], Manzoor et al. [171], Almulhim et al. [172], ative interest high))
Rezaeibagha et al. [173], Zhang et al. [174], Aman et al. [175], Ankergård et
al. [176], Ren et al. [177]
Transitive, Rekeying, and non-repudiation Yoon et al. [178], Lizardo et al. [179], Rao et al. [180], Tan et al. [181], Ammar With an overall (14% (rel-
authentication schemes for HC-IoT net- et al. [182], Sidhu et al. [183], Cui et al. [184], Hassan et al. [185], Li et al. ative interest medium))
works [186]
Attestation based authentication schemes Lin et al. [187], Abdi et al. [188], Pallavi et al. [189], Yao et al. [190], Kim et With an overall (8% (rela-
used for HC-IoT networks al. [191], Loukil et al. [192] tive interest low))
and biometric was proposed to resolve the authentication Attestation is a security technique used for discovering un-
problem in HC-IoT networks. The recent analysis of reference expected and spiteful modifications in an application, software,
[160], disclosed that this model was flawed and unprotected and hardware [175], [176]. Attestation is capable to allow and
against a variety of threats, due to its simple authentication maintain a high standard of security by imposing extremely
process. reliable hardware preservation, authentication, and verification
References [161]–[164] used an integrated authentica- schemes at the design and operation phase. Likewise, remote
tion protocol for HC-IoT networks that combines biometric attestation methods are solely based on algorithms, which
and user names/password rather than a two-factor solution, normally rely on extremely strong assumptions that could be
whereas Guan et al. [165] used passwords, smart cards, and obtained in reality with rare exceptions [158].
biometric collectively to validate a legitimate client in the Furthermore, the authors explained that attestation could be
network. In [166], various biometric authentication models performed in a real-world setting using Trustworthy Execu-
were discussed and summarized with their advantages and tion Environments (TEEs) models supported by trustworthy
disadvantages. hardware companies such as ARM TrustZone (ARM-TZ),
3) Non-repudiation authentication schemes: Trusted Platform Module (TPM), and Intel SGX, etc. [177]–
[180]. In order to improve the defense and system durability
Non-repudiation is a text message attribute that ensures the against malicious devices and attacks, various attacks and
author’s record and prevents him from denying his authorship their countermeasure schemes are discussed in the literature
in any text document, authentication request or network hijack- [181]–[183]. At present, there are very limited projects on
ing, etc. Fraile et al. [167], offered some specific explanations trusted hardware in the area of (HC-IoT and IIoT networks).
about non-repudiation by highlighting different security condi- Therefore, almost all of the existing attestation protocols work
tions. To explore, if a user is engaged in criminal activities, and as a general situation rather than a particular environment.
the network administrator has a way to detect these acts. Once,
the malicious activity is detected, then, in the investigation E. Access control and resilience
phase, the non-repudiation property of a message should be
used as evidence to identify the exact infiltrator as confirmed Access control (AC) techniques had been used in various
by Ankele et al. [168]. In this article, the author’s demonstrated HC-IoT applications to ensure the security of all involved
an example scenario, where the manufacturer discovers setup stakeholders. These techniques are very useful because they
files on certain hardware. For this, Ankele et al. used an provide two kinds of accessibility to the customers such as
automatic software update procedure to reconfigure online the ordinary users/clients of the applications and server managers
firmware of installed IoT devices. In this case, the removal of to control the accessibility to deployed devices, upgrade the
such system or file settings cannot be tracked back during firmware of different devices, apply and execute system se-
program upgrades without a non-repudiation process. The curity policies, etc, [184], [185]. To explore this topic, Li
most recent work related to the HC-IoT and IIoT applications et al. [186] suggested a lightweight certificate-less signature-
non-repudiation attacks and their counteraction schemes is based authentication scheme for the HC-IoT applications with
discussed in references [169]–[174]. an objective to minimize the energy consumption during
4) Attestation based authentication schemes: authentication at the client-side. In this scheme, the legit-
imate users/devices rely on the network’s trusted authority
10
(TA) to execute authentication parameters via cryptographic detection scheme to address the security problem associated
operations. with IoT application network traffic. In this model, the author’s
Lin et al [187] introduced a blockchain-based authentication also considered several resilience-related problems i.e. incon-
protocol for HC-IoT applications to address the authentication, sistent access to the network, which can cause enormous data
validation, verification and the access control issues in these loss in terms of centralized location e.g. cloud, or database,
networks. Despite this, Abdi et al. [188] built a hierarchical etc.
lightweight access control framework for these networks by References [207], [208] showed a variety of alarming indi-
utilizing a ring signature mechanism to ensure the legitimacy cators that directly highlight the security problems associated
of participating devices in the network. In this framework, with the resilience of HC-IoT networks. In reference [223],
the client’s authenticity is ensured by grouping them into this topic was further explored with the presentation of a
similar classes, where different access control rules were brief survey on the resilience of the security requirements
applied for each class. Pallavi et al. [189] recommended for industry 4.0 IoT networks. In Fig 4, the percentage
a blockchain-enabled authentication scheme for the HC-IoT access control and resilience security requirements of HC-IoT
applications with the recognition of adaptive access control network are illustrated that had been considered in this survey
and decentralized management techniques. In this model, the paper.
authors make use of smart contracts and non-repudiation to
ensure the integrity of communication and the authenticity of F. Security maintainability and monitoring
users. Yao et al. [190] suggested a fog-enabled access control
approach for HC-IoT applications utilizing the attribute-based In this section, we will look at the complexities related to
credentials of patient wearable devices followed by distributed the maintainability of a secure HC-IoT network by describing
access control policy to ensure the integrity of users and the traditional maintenance strategies that are inadequate or
network traffic. In the context of this discussion, Kim et al. unable to fulfill the maintenance needs of these networks.
[191] suggested a situation in which entities were connected To begin, maintainability is the strength of modification,
in a multi-hop communication infrastructure, whereby they rearrangement, and up-gradation of devices, software, and
follow their security protocols to process data from source hardware, etc. With this, the idea regarding maintainability
to destination. became more influential in HC-IoT application, because of
Following this discussion, Loukil et al. [192], proposed the security requirements of these networks [209]. In [210],
a lightweight hybrid authentication scheme for HC-IoT ap- the authors suggested that the provision of authentication,
plications. This model manages the legitimacy of intercon- validation, verification, and software patches are the primary
nected devices during the communication process by means security concern of HC-IoT networks. For this, the authors
of authentication, and authorization. According to Aloqaily et present a strategy that guarantees the secure software update
al. [202], the severity and sophistication of security breaches of employed devices with an assessment process to catch
had increased in the recent decade, therefore, this is a must- high-risk vulnerabilities in operational networks. Yadav et al.
need situation to incorporate vulnerability appraisal through- [211] designed an intelligent anomalies detection scheme to
out the information exchange in the HC-IoT applications by identify malicious updates of compromised IoT devices in an
defining access control rules. Industrial Internet Consortium operational network. However, this model was very complex
(ICS) had published an article regarding the security concerns that minimized its use in real IoT applications. Following this
of HC-IoT applications by discussing the most prominent discussion, Seitz et al. [212] argued that upgrading the IoT
data preservation and authentication techniques [203]. In this network is invariably a difficult and tedious operation because
article, they highlighted and described that resilience is the it requires an experienced specialist to conduct an upgrade
emerging attribute of IoT devices that allow them to bypass, the employed devices software and hardware with reliable
assimilate, and manage composite events while performing performance. In the redressal of this, the authors suggested that
delegated tasks. Additionally, this paper overlapped with many the upgrading process should be an automated and simplified
other review articles published on security aspects of HC- one to maintain generality. Sowjanya et al. [213], noted and
IoT applications such as confidentiality, availability, reliability, suggested that cryptographic keys need to be managed with the
and performance, etc. References [200], [204], [205] followed ability to be modified safely in an operational network. There-
up this topic by highlighting the important security issues fore, it is necessary to design a simple and efficient anomaly
associated with the HC-IoT applications in the context of detection model for these networks to ensure their security. In
resilience. The authors also discussed the facts of resilience Khan et al. [214] article this topic was explored to present a
complications, framework and standards that poses multiple scenario-based example of this problem by outlining a range
challenges in terms of security. Likewise, the satisfaction of the of conditions for the secure maintenance of an employed
resilience criterion relies strongly on the network implementa- network. As in a dynamic communication environment, it is
tion architecture, environment, and security. In small networks, important to track and react to suspicious activities that can
it might be appropriate to merely introduce sufficient sensors hamper employed patient wearable device operations during
to ensure some consistency during the authentication process. maintenance. To do this task securely, special tools such as
But in heterogeneous HC-IoT applications, it is not possible Intrusion Detection System (IDS) and Intrusion Detection &
to address these concerns without a proper authentication Presentation System (IDPS) could be extremely helpful at the
framework. Arachchige et al. [206] presented an anonymity client-side as well centralized location [215], [216].
11
Access Control and Resilience Security Requirements Relative Percentage
Operation with
Compromised Devices 32 %
Software & Configuration

Updateability 26 %
Compatibility, Traceability &

Secure Data Transfer 15%
Intermittent Devices
Operation 11 %
Transparency &
Usability Updates 9 %
Standard
compliance
7%
Fig. 4: Percentage security requirement of access control and resilience with their specified name
To extend this discussion, Hasan and Mouftah [217] ar- from the present literature i.e. (Network security, CIA, main-
gued that delay is among the biggest barriers for security tainability, and monitoring, resilience and access control, etc.)
monitoring systems because IoT devices are dispersed over that are discussed in the preceding sections. Furthermore, we
a large geographical area. Therefore, the new design IDS will compare this section with comparative survey papers in
and IDPS technologies are intended to work in a delay TABLE V to claim the uniqueness of our work in terms of
sensitive environment. Reference [218] suggested an Intrusion in-depth and distinct literature evaluation.
Detection System, which had a self-adapting facility with the Likewise, in the second part, we outlined different obser-
network. This system uses the records detail of all intercon- vations presented in the literature into two categories. In the
nected devices to detect malicious devices and activities in first part, we categorized the evaluated papers in TABLE VI
the employed network. Deshpande et al. [219] offered an with respect to the topic followed by number and percentage.
additional case study of specific system security requirements When we exploring the prominence of the categories listed
by demonstrating a heartbeat protocol tailored exclusively for in TABLE VI, a few observations have been made in our
HC-IoT networks. Marchetto et al. [220] demonstrated in study such as authentication resembles greater importance in
their article that extra communication and protection across HC-IoT networks, including data security i.e. CIA. Following
at the end users or devices is treated as security conditions this, authentication of legitimate devices in the HC-IoT net-
for the deployed network, which can be understood by these work is also great importance and assumed to be the most
devices as a security policy. Hu et al. [221] recognized delay common condition for every network to ensure the legitimacy
in the HC-IoT networks as a problem and claim that the of interconnected devices. Therefore, we have discussed all
consistency, software, and customization of communication interrelated things of authentication very comprehensively in
networks play a vital role in reducing latency. As a result, this paper. Likewise, we have elaborated on the categories of
the implicit prerequisite of the HC-IoT environments must be resilience and maintainability followed by their importance
controllable and customizable at all stages. In addition, we in an employed network. As a result of this detailed study,
analyzed the maintainability and monitoring security of HC- we revealed that this is a promising field for future study.
IoT in Fig 5, because these aspects are completely ignored in However, access control, models, or methodologies also seem
the comparative papers. to be the least common presumably because of the security
specifications and network architecture. Multi-factor and mu-
tual authentication are often discussed in various contexts in
G. Summary of Discussion our paper to familiarize the reader with their importance fol-
lowed by their function and results. What distinguishes these
In this section, we have collected the security requirements categories from the others as discussed in our paper is their
based on different types of network parameters and modules popularity with relatively diverse requirements incorporated in
12
Maintainability and Monitoring

Security Requirements
Data
Migration 2%
IDS Monitoring 5 %
Data Confidentiality 6 %
Secure data Transmission 6 %
Heterogeneous HC-IoT Monitoring 7 %
Security Policy Enforcement 8 %
Threat Response Monitoring 11 %
Flow Control Maintainability 14 %
Infrastructure Monitoring 19 %
Standardization maintainability 21 %
Fig. 5: Maintainability and Monitoring security requirement statistical analysis
TABLE V: Authentication scheme used for HC-IoT Networks Comparative Analysis

Authentication Meneghello et Qadri et al. Bhuiyan et al. Alshehri et al. Zakaria et al. Butpheng et Our Survey
Framework Name al. [10] [11] [12] [13] [14] al. [17] paper
Authentication Yes No Partially Yes Yes Yes No Yes
through key
distribution
Attestation based au- No No No No No No Yes
thentication schemes
Access control and Yes No No No No No Yes
resilience
Mutual and multi Partially Yes No Yes Partially Yes Yes Yes Yes
factor authentication
schemes
Non-repudiation au- No No No No No No Yes
thentication schemes
Security No No No No No No Yes
maintainability
and monitoring
TABLE VI: Total paper evaluated are distributed category wise followed by (%) ratio
Description of category Number of related papers Relative percentage (%)
Network security 40 19.32%
Multifactor authentication 35 16.9%
Mutual authentication 25 12.07%
Maintainability 15 7.24%
Access Control 17 8.21%
Data Security (CIA) 46 22.22%
Resilience 13 6.28%
Models 16 7.72%
13
the literature. As a result of this, when we look at TABLE VII,

where we have addressed and highlighted the requirements
of HC-IoT applications with their popularity to figure out
the security requirements of these networks. Furthermore, we
HC-IoT
declare that these requirements could be the most accessible Security
related to the HC-IoT network security, which allows us for a Threats
wide range of works to be performed in this field in the future.
IV. E XISTING T HREATS C OUNTERMEASURE S CHEMES

A. Question 2
In this section, we expand our discussion to address research Fig. 6: Different Types of Security Threats to HC-IoT Appli-
questions two and three by examining published articles re- cations
lated to HC-IoT security with their venues to set the foundation
for comparative analysis. First, we talk about the the different
layers of the OSI model and network infrastructures that allows devices, network entities, and physical layer communication
the attacker to target HC-IoT applications. Considering that, infrastructure. Furthermore, the authors highlighted several
we can see that the healthcare industry continuously getting attacks that had been used to hijack the security of an
benefits from emerging technologies, and HC-IoT is among operational network. Here, we examine some of them such as
them. This technology helps to make any long and tedious radio jamming, frequency jamming, node spoofing, physical
process easier to complete by allowing doctors and medical node capturing and damaging, malicious node injection, etc.
staff to use amazing tools in their patient assessment, surgeries, Cao et al. [224] extended this discussion by proposing a semi-
and prescriptions. Before the adaptation of technology, patients grant-free Nonorthogonal Multiple Access (NOMA) transmis-
had to wait for hours to get examined and staff had to complete sion prototype to mitigate active eavesdropping attacks in
the documentation tasks manually. Moreover, patients used to IoT applications. Considering the limitation of the present
visit hospitals to interact with doctors, or a phone call and literature, the author claimed its superiority against said at-
text. And there was no way to monitor the patient’s health tacks. Consequently, Sharma et al. [225], presented a survey
continuously to make an immediate and accurate diagnosis. paper, and highlight the advantages and disadvantages of
The advancement of the Internet of Medical Things (IoMT) different machine learning approaches that have been used
and Artificial Intelligence (AI) in healthcare ensures to analy- to prevent physical layer security threats in IoT applications.
sis the medical history, body scanning, disease diagnosis, and Researchers are interested in a more in-depth analysis of the
monitoring of patients [222]. It is necessary to note that this physical layer security threats and their preventive techniques
technology is still in its evolving phase and faces various chal- are recommended to go-through this article.
lenges that include interoperability, quality of services (QoS),
integration, and security. While each of these factors has its C. Network Layer Security Threats
own implications, but security is particularly critical. Unlike In this subsection, we discuss the network layer security of
other factors, security cannot be solely managed through IoT applications, a critical aspect ensuring the secure intra and
hardware or software, because attackers continuously seek interconnectivity of network entities such as patient wearable
new ways to compromise the security of HC-IoT applications devices and other communication technologies via the internet.
that potentially leads to the theft of patient, staff, and doctor Security measures at the network layer focus on the encryp-
records. Which has life-or-death consequences for individuals’ tion protocols, authentication mechanisms, access control, and
lives, as disruptions in vital medical equipment like pacemak- intrusion detection systems, etc. [226]. Therefore, robust net-
ers, life support systems (LSS), or internet-connected oxygen work layer security is crucial for HC-IoT applications to pro-
supplies can disrupt the treatment process [2]. In this context, tect them against unauthorized access, authentication, eaves-
we aim to explore various security vulnerabilities by taking dropping, and man-in-the-middle attacks in an operational
into account the OSI model and user interface. Moreover, these environment. Considering this, Kumari et al. [227], presented
susceptibilities exist in several forms such as external threats, a comprehensive survey regarding the network layer attacks
internal threats, and accidental or malicious software updates. of HC-IoT applications and their countermeasure schemes.
Given that, we outline the categories of security vulnerabilities Researchers, students, and industry stakeholders interested in
as follows (Fig 6). exploring this area are advised to go through this article.
B. Physical Layer Security Threats D. Application Layer Security Threats

In this section, we talk about the physical layer security In this subsection, we talk about the application layer
threats and their corresponding countermeasure strategies with security of the HC-IoT applications because it ensures data
the intention to highlight the existing research gaps and set privacy, user authentication, and interconnected devices in
the stage for future work in this area. In [223], the authors the network. In HC-IoT, the application layer focuses on
explained that physical security threats of HC-IoT applications the communication and interaction between devices and end-
deal with the protection of hardware of patient wearable users, which makes it a prime target for potential threats
14
TABLE VII: Individual requirement relatively interest with their percentage (%) ratio
Security requirement Description of category overall relative percentage (%)
Secure information exchange Information security Very high (10.2% )

infrastructure monitoring (network) Security monitoring Very high (8.1%)
Multi-factor and mutual authentication authentication Very high (7.7%)
Secure data storage Data security Very high (7.2%)
Wireless transmission medium security Network Security High (5.3%)
Threat or attack response Network Security High (5.1%)
Key distribution for centralized location Authentication of legitimate devices High (4.5% )
Threat and risk assessment Models and techniques High (4.4%)
Decentralized authentication Access control High (4.3%)
User interpretation avoidance authentication schemes High (4.2%)
Time stamping and timeliness Authentication schemes Moderate (Medium) (3.5%)
Attestation Authentication schemes Moderate (Medium) (3.2%)
software update-ability Maintainability software & systems Moderate (Medium) (3.0%)
Privacy and data preservation Authentication Authentication schemes Moderate (Medium) (2.8%)
Availability Network Security Moderate (Medium) (2.6%)
Secure data transport Network Security Medium (2.2%)
Non-repudation Authentication schemes Medium (2.0%)
Node addition and revocation Authentication schemes Medium (1.98%)
Configuration updateability Maintainability software & systems Medium (1.91%)
security policy enforcement Network Security requirement Medium (1.8%)
Standards compliance Resilience standards Low (Medium) (1.75%)
Data protection legislation Network Security Low (Medium) (1.65%)
Operation with compromised subsystems Resilience standards Low (Medium) (1.45%)
Attack traceability Overall Network Security Low (1.35%)
Compatibility Maintainability software & systems Low (1.30%)
Intermittent connectivity Resilience standards Low (1.20%)
Data loss mitigation Data preservation & security Low (1.10%)
Transitive authentication Authentication model Low (0.98%)
Standardization Data and network security Low (0.85%)
Overhead management minimization Overall Network Security Low (0.8%)
and attackers. Recently, the attackers used HTTP floods, for secure communication in edge-enabled IoT, termed as
SQL injections, parameter tampering, cross-site scripting, and TACAS-IoT. The authors present compelling results showcas-
Slowloris attacks to compromise the security of legitimate ing the scheme’s efficacy against various attacks. Nonetheless,
networks for the application layer [228]. Security counter- there remains a pressing need to assess this model in contexts
measures at this layer involve authentication, access control, involving mobility and handover processes to determine its
and data encryption to protect the sensitive data of healthcare result statistics. Researchers interested in exploring this topic
users and staff from unauthorized access. Given that, robust further are advised to go through the survey article [231], the
security protocols could play a pivotal role to guarantee the authors discussed several key matching-based authentication
integrity and confidentiality of data in HC-IoT applications. schemes with their advantages and disadvantages.
Therefore, addressing security concerns at the application layer 2) Biometric and Identity based authentication: In this part
is imperative for building trust and facilitating the widespread of the paper, we discuss the biometric based authentication
adoption of HC-IoT technologies. schemes that have been used to address the security chal-
lenges of emerging technologies such as IoT applications.
E. Classification of Present Literature In [232], the authors discussed different security issues and
In this section, we examine the current security techniques challenges of IoT applications in the context of biometric
with their contributions and limitations to verify the research security. The authors evaluated the present literature, and
gap. Moreover, we talk about AI approaches and how effec- considered different network, communication, and use-ability
tively they can handle and resolve certain security issues. To aspects to highlight the pros and cons of these schemes.
achieve this objective, we have compiled latest research papers Reference [7], proposed a robust authentication protocol based
publish between years 2015 to 2023, all of which include on a public key infrastructure (PKI) with digital certificate
experimental evaluations TABLE VIII. matching to ensure the security of IoT applications. Authors
1) Key based authentication: In this section, we talk about verified and validated the proposed model using the Tamarin
the key matching based authentication schemes that had been prover framework for different attacks scenarios. To evaluated
used recently to counter different security attacks in HC-IoT more comprehensively the biometric based authentication and
applications. Considering that, Amande et al. [229], proposed identity based authentication schemes, the readers are advised
a Lightweight Authentication Scheme with User Anonymity to go through these articles [233], [234].
(LASUA) to resolve the authentication and data privacy prob-
lems in IoT applications utilizing Elliptic Curve Cryptography F. Comparative Results Analysis
(ECC). Wazid et al. [230], extend this discussion by propos- Discuss the recent literature associated with security
ing a novel trust-aggregation-enabled authentication scheme challenges of HC-IoT applications in the context of their
15
TABLE VIII: Security requirements of HC-IoT applications (Question 1)

Ref Security Type and Proposed Approach Experiment Result Statistics
Issues Framework
[235] Physical Layer In this work, the author used an RFID Simulation Useful results are claimed
security and RFID based authentication model for IoT appli- Environment in presence of compara-
based authentication cations with a focus on both security and tive schemes (communica-
performance. tion and computation cost)
[236] Verification, In this article, the author presents a Simulation Evaluated for authentication,
Authentication, certificate-based approach for large-scale Environment authorization, and end-to-
and authorization concurrent data anonymous batch verifica- end data security
(Network Layer) tion in mobile healthcare IoT applications.
[86] Cross Layer Secu- In this paper, the author proposed a hybrid Cloud Network throughput, data
rity Framework framework of Meta Fog-Redirection (MF- computing security, accuracy, and f-
R) and Grouping and Choosing (GC) to infrastructure measure
ensure the big data security of HC-IoT.
[237] Anomalies DL-enabled anamolies detection in HC- IoT-Botnet Accurate classification ,
detection with IoT connected in the form of blockchain and ToN-IoT predication, and detections
encoders networks. datasets
[238] Edge side In this article, the author proposed a FL- Simulation/pre- Accuracy and predication
security/patient enabled data privacy model to ensure data trained model
wearable devices security at the client-side.
[239] Dos/DDoS flooding In this work, the author proposed a Dy- Simulation attack detection accuracy
attacks. namic Secure aware Routing protocol for environment 98.19%
healthcare data analysis using ML model.
pros and cons. With this, highlight the venues of present and 6%, respectively. Furthermore, it also acknowledges to
literature continent-wise? the research community and different countries of the world
The objective of this evaluation is to acknowledge the that how important this domain is, and what its future looks
contributions of different countries in this domain, and draw like. Therefore, they need to utilize their resources to plan
the attention of other nations toward this important topic. a better tomorrow. In addition, the potential understanding
The topographical dissemination of the investigation venture behind this research intervention is that the term ”Industry
is defined as the number of research conducted and published 4.0 IoT network” was coined by European countries [240]–
throughout the globe. For concrete analysis, we checked the [242] to acknowledge the importance of different applications
maximum author’s wise affiliation with respect to the country importance and particularly the security of these applications.
to organize the continent-wise study in an understandable As a result, it should be observed from the statistical anal-
manner. Despite that, we also checked university-wise ranking ysis that European countries had shown great interest in the
to ensure the legitimacy of results in terms of accurate analysis. said domain by high publications as shown in Fig(s) 7 and
8, respectively. In addition, the highlighted problem of our
paper is flourishing to present a good global example to the
healthcare industry by drawing their attention to this domain.
Furthermore, we understand the security of HC-IoT networks
Europe
is ignored and earned insufficient consideration in the recent
38.16 %
past. Therefore, we have explicitly looked for patient issues
in terms of security requirements to collect exact information
America
Continent wise for setting the future research direction.
18.35 %
contributions %
To ensure the research of the aforestated domain, we

Asia checked the top university ranking in terms of publications
26.08 % to overview revolution of this technology. Although, USA is
in the top spot of university ranking, but their contributions
in the field of HC-IoT is comparatively lower than other
continents. This exhibits that this technology is still in the
revolutionary phase because a well-developed country such
Fig. 7: Statistical analysis of continent-wise publications as the USA is still working on it. China spots second in the
top-ranked university list followed by Japan, Singapore, Hong
Fig 7 shows the continent-wise research contribution for the Kong, India, and Malaysia.
aforestated topic, whereas European countries hold first place
in the analysis report with an overall contribution of 38.16 %
followed by Asia with 26 %. Similarly, America, Australia, Fig 8 demonstrates the current top 10 countries in terms of
and Africa follow them with the percentages of 18%, 11%, the continents to show the contributions graphically.
16
to present a way for new thoughts on the current problem and

a reference of motivation for the forthcoming research studies
rather than advising a comprehensive study analysis. In the
literature, it has been noted that how Edge computing, Fog
computing, Cryptography, and Routing protocols demonstrate
potential for overcoming these challenges [243]. Some of the
undermentioned topics would be of remarkable interest to
address the existing challenges that have been discussed in
the preceding sections.
.
Fig. 8: Years-wise publication used for this survey
A. Decentralized Authentication Challenges
In HC-IoT applications, the authentication of legal
patient wearable devices, IoT devices, and other networking
components in a distributed network is a challenging task,
because of the various factors, which has been highlighted
and discussed in the previous section. To explore, during
authentication of these resource constraint devices various
communication aspects can be monitored to ensure the
validation and verification of legal devices in any HC-IoT
application with minimal resources. Following this, we have
Fig. 9: Years-wise publication used for this survey noted in the literature that most of the existing techniques
use centralized authentication authority for fixed-employed
networks, which can create network overhead in terms of
congestion and contention followed by scalability issues.
With this, we also have recorded that edge side devices
are resource-limited, and enabling authentication of these
devices in such fashion misuses their limited resources in
a meaningless way because they do extra computation and
communication. Keeping in view, the present literature,
we acknowledge that authentication of healthcare IoTs in
a distributed network is still an open challenge for the
research community and industry partners to devise reliable
Fig. 10: Publication venues statistical analysis
authentication models and resolve this issue in an effective
way.
G. Question 3
Future research initiatives
How has research on HC-IoT applications security To address the aforementioned challenges in the existing
evolved over the years across various publication venues? HC-IoT applications, the role of edge computing in
In Fig 9, we showed and categorize the year-wise publications, coordination with a machine learning algorithm, deep
which have been evaluated in this review article. learning algorithm, and reinforcement learning algorithm can
Furthermore, we classify the literature according to not be ignored, because they have the capability to assess
databases i.e. IEEE Xplore, ScienceDirect, ACM Digital Li- network traffic data on the client side for different attacks
brary, Google Scholar, and PubMed, etc. The statistical anal- based on the trained model or previous experience. Therefore,
ysis based on the aforementioned databases is shown in Fig we believe that this technology can play a paramount role in
10. the redressal of the aforesaid challenges. With this, we also
suggest that the importance of collaborative knowledge in
V. O PEN C HALLENGES WITH F UTURE RESEARCH the context of data sharing can not be neglected and must
O PPORTUNITIES / DIRECTIONS be used in cooperation with the aforestated technology to
address the authentication problem in any HC-IoT application
In this section, we will talk about the open security chal-
in an effective way by considering its scalability aspects.
lenges that have been identified during the literature evaluation
phase. With this, we will also talk about the possible solutions
that could be useful in the future for redressal of them. For
this, we have underscored a number of materializing topics that B. Cost Effective Multi-Factor Authentication Challenges
have the capability to address these challenges and attract note- In HC-IoT applications, cost-effective multi-factor
worthy attention from the market stakeholders followed by the authentication is another challenging task, because the
research community. To explore, the purpose of this segment is existing literature does not present a reliable and concrete
17
authentication model that is capable to manage multi-factor method for resolving this problem in a decentralized setting
authentication of patient wearable devices, IoT devices, and with the least computation cost. This is another future research
other networking components in a cost-effective way. For direction, which needs proper concentration of the research
this, the research community needs to consider distributed community because the present state of the art still lacks
authentication rather than centralized with an emphasis on to resolve the credential update, auto firmware update, and
multi-factor authentication, as the existing literature lacks access control policies problems with a decentralized approach
these types of authentication model. utilizing network components such as edge nodes.
Future research initiatives D. Maintainability and Monitoring Security Challenges

To address the multi-factor authentication problems in HC-
In HC-IoT applications, the maintainability and monitoring
IoT applications effectively, some edge nodes could be used
of network entities and system security is a challenging task
as an authentication server to ensure distributed validation of
for administrators and network operators. Lose maintainability
legitimate devices in the network. With this, the authentication
and monitoring framework of these applications offers many
time can be reduced with significant improvement followed
security vulnerabilities to an operational network by means of
by efficient key distributions or key allocations, as discussed
code injection, trojans, malware, etc. Open area deployment of
in reference [236]. Therefore, we believe that if some edge
patient wearable devices, IoT devices, and networking entities
nodes are configured to perform the role of an authentication
keeps the door open to internal and external hackers. There-
server in the network, then various security obstacles can be
fore, we acknowledge the research community and industry
resolved in terms of authentication via a third party on the
stakeholders to pay proper attention toward the redressal of
client side. Despite this, edge nodes could serve as a trusty
this challenging task.
party for the vicinity devices to ensure the implementation
Future research initiatives
of conventional PKI infrastructures, and serve as ”certificate
To address the security concerns coupled with the main-
authority” for local devices by inaugurating a steadfast key
tainability and monitoring of the HC-IoT applications. AI-
exchange infrastructure in the network. To the best of our
enabled-Blockchain infrastructure could be used as an ef-
knowledge, no work had been performed in the literature to
fective technology because it has the ability to guarantee,
utilize edge nodes as a trusted authority on the client side
maintain, and monitor the security of an employed HC-IoT
to investigate or devise new novel authentication for HC-IoT
application in a distributed environment. Furthermore, we
applications and resolve its security concerns cost-effectively.
believe that AI-enabled-Blockchain technology could be very
useful to minimize the communication and computation costs
C. User’s Awareness Security Challenges in these applications, and improve the overall performance of
the employed network. Despite this, the software up-gradation
In HC-IoT applications, security awareness capabilities of
and configuration of patient wearable devices, IoT devices, and
IoT users is another challenging task, because it is indisputable
other networking entities would be enabled in a decentralized
to gain unauthorized access to patient wearable devices, IoT
environment securely. Following this, we suggest the research
devices, or other networking components either through brute-
community and market stakeholders to develop secure AI-
forcing attack or by hijacking the default credentials of these
enabled-Blockchain techniques for HC-IoT applications in the
entities. Therefore, it is very important and challenging to
future.
take care of the default credentials of these entities. For this,
the network administrator could be capable to implement new
policies or modify the default hard codes of these devices E. Interoperability Security Challenges
in an operational network. However, the existing literature
lacks to present such access control policies that could be In the existing literature, many researchers have suggested
capable to counter different threats associated with access several Interoperability standardization frameworks for HC-
control of the system. Therefore, we want to bring the attention IoT applications to address their security considerations. But
of researchers, students, market partners, and other involved still, these frameworks lack to manage these problems prop-
stakeholders toward this challenging problem to design cost- erly, as the vendors, operating system, communication, and
effective access control techniques. working behavior of participating or interconnected devices
Future research initiatives are different from each other. Keeping in view the limitations
To address the aforestated problem, reliable credential up- of the present work, Interoperability with a reasonable security
date, auto firmware update, and access control policy tech- framework is always an open research challenge in HC-IoT
niques are needed to be developed by the research community applications. Therefore, we want to acknowledge the impor-
and industry stakeholders collectively. Therefore, we suggest tance of this problem to the research community, national,
all stakeholders working in this domain to pay attention to and international stakeholders to design globally applicable
underscore research work. Edge nodes with credential update, standards for such applications in the future.
auto firmware update, and access control policies management Future research initiatives
can boost the responsibilities in industrial scenarios when it To address the security problems associated with the In-
comes to the security concerns of the end-users or devices. teroperability of HC-IoT applications, the role of machine
Therefore, we believe that edge nodes may be an efficient learning, reinforcement learning, and deep learning can not
18
be neglected, because they demonstrated remarkable results management with Fog node in a decentralized network offers
in the past. However, when it comes to the scalability of the multi-factor authentication challenges, because who will be
existing HC-IoT applications, then these models are not very responsible for storing the authentication parameters? With
effective, because they work according to defined datasets or how we to establish a cohesive and secure connection between
past experience. Therefore, we suggest the people working fog nodes and cloud platforms within HC-IoT networks.
in this domain to use transfer learning-enabled techniques in Future research initiatives
the future to address different problems connected with the In the HC-IoT application, addressing the security chal-
Interoperability of HC-IoT applications. lenges in a distributed environment is challenging. However,
the role of fog nodes in a distributed setup becomes evident
F. Blockchain-enabled HC-IoT Security Challenges to handle them effectively. These nodes are equipped with
advanced capabilities, which make them serve both as effec-
tive policy executors and as intrusion detection systems by
In this section, we talk about Blockchain-enabled healthcare
detecting network irregularities. The synergy between fog and
IoT technologies in the context of open security challenges.
cloud computing offers a holistic approach to network security.
First, the scalability of blockchain-enabled HC-IoT applica-
With IDS and IDPS systems integrated into a cloud infras-
tions often suffers to support the vast number of IoT devices
tructure supported by fog nodes, there’s a powerful defense
with existing authentication schemes. Secondly, data privacy is
line against client-side security issues. Given their potential
another concern, because it is not sure who will be responsible
to mitigate threats, it’s crucial for the research community to
for keeping and storing the user’s data secure. Next, the inte-
use fog nodes in future HC-IoT applications security redressal
gration of existing HC-IoT technologies with new blockchain-
problems.
enabled platforms offers interoperability concerns. Does the
existing software and hardware will satisfy this need? If not,
how it should be ensured? Lastly, the energy consumption H. Machine Learning and Its Subsets Security Challenges
of some consensus mechanisms, like Proof-of-Work, may not
be sustainable for healthcare IoT networks. What alternative In HC-IoT applications, the incorporation of machine learn-
techniques can be used to resolve this problem? ing and its various subsets, such as deep learning, reinforce-
Future research initiatives ment learning, and transfer learning offers unique security
In blockchain-enabled healthcare IoT applications, the re- challenges. Deep learning, for instance, introduces complexity
dressal of security problems is a tedious task, when it comes to and opacity into models, which can render them vulnera-
application scalability, data privacy, and integration. Software- ble to adversarial attacks. Minor adjustments to input data
defined networking (SDN) technology could be used as a can result in significant misclassifications. In the context
promising solution, because it has the capability to tackle of reinforcement learning, the utilization of exploration and
it with the help of the decentralized controller. They can exploitation techniques can introduce vulnerabilities. Even a
deftly manage a vast number of IoT devices and ensure that minor manipulation of policies or behaviors could have serious
sensitive health data remains secure. Furthermore, the inter- implications for patient health, records, and assessments, etc.
operability problems inherent with the integration of different Transfer learning, which involves reusing pre-trained models,
technologies, can be also navigated more efficiently with SDN raises concerns about potential data leakage and model con-
controllers. These controllers, when synergized with machine tamination from previous datasets. Therefore, it is imperative
learning techniques such as deep learning, transfer learning, to proactively consider and implement preventive measures to
and reinforcement learning, then their potential can be more mitigate potential threats in these applications in the future.
improved to detect malicious activities in the network. Conse- Future research initiatives
quently, to truly harness the potential of blockchain for HC-IoT To counteract the security pitfalls of machine learning and
and address the enumerated challenges, a collaborative effort its derivatives in the HC-IoT applications, future research
between the research community and industry stakeholders should prioritize creating robust models resistant to adversarial
focusing on SDN controllers and machine learning is pivotal. attacks. This can be achieved by developing methodologies for
regularizing deep learning networks or introducing adversar-
G. Fog Computing-enabled HC-IoT Security Challenges ial training practices. For reinforcement learning, researchers
could explore safe exploration techniques that ensure the algo-
In HC-IoT applications, the utilization of fog nodes presents rithm’s operation within predetermined safety bounds. In the
several security challenges. One primary challenge is the scal- case of transfer learning, refining domain adaptation strategies
ability and capacity of fog nodes to handle an ever-increasing and enhancing model auditability can minimize data leakage
influx of data from end devices to remote destinations securely. and contamination risks. By focusing on these avenues, we
Because the current capabilities of fog nodes need to be re- can potentially harness the full potential of machine learning
evaluated, particularly regarding how they adapt to dynamic in HC-IoT while maintaining robust security.
security policies in an HC-IoT network. Secure integration
and ensuring compatibility with varied HC-IoT infrastructures, VI. C ONCLUSION
such as sensors, patient wearable devices, and cloud plat- In this paper, we presented a comprehensive survey regard-
forms is another serious concern. Moreover, secure resource ing the security concerns of HC-IoT applications by evaluating
19
TABLE IX: Future Research Opportunities Comparative Analysis

Research Directions Meneghello Qadri et al. Bhuiyan et Alshehri et Zakaria et Raghuvanshi Our Survey
et al. [10] [11] al. [12] al. [13] al. [14] et al. [15] paper
Edge nodes enabled authentica- Yes Yes No Yes No No Yes
tion in HC-IoT
Edge nodes enabled mutual and No No Partial Yes No No Partial Yes Yes
multi factor authentication
Edge nodes enabled Access Con- No No No Partial Yes No No Yes
trol and Resilience
Security Maintainability and Yes Yes Yes No No No Yes
monitoring through Edge nodes
SDN-enabled authentication in No Partial Yes No Yes No Yes Yes
HC-IoT
Fog computing enabled Security No No No No No No Yes
Monitoring in HC-IoT
AI, ML, and DL enabled authen- No No No No No No Yes
tication
Fog Node enabled authentication No No No No No No Yes
in HC-IoT
Complex Cyber Threats Detec- No Partial Yes No No Yes Partial Yes Yes
tion in HC-IoT through Machine
Learning
Data privacy and preservation No No No No No No Yes
through AI, ML, and DL
AI and Blockchain-enabled au- Yes No No No Yes No Yes
thentication
the existing authentications and data preservation schemes. Al- Khan is supported by King Saud University, Riyadh, Saudi
though, it is extremely difficult to include all related literature Arabia under project number (RSP2024R12).
in one survey paper, but a fair representation of related work is
more critical rather than a large number of publications. For
this, we methodologically built search queries by searching R EFERENCES
various database sources to obtain a good portrayal. After [1] S. Kumari, M. K. Khan, and R. Kumar, “Cryptanalysis and improve-
that, we practiced the contrary sampling technique to boost ment of ‘a privacy enhanced scheme for telecare medical information
the output of our queries even more by removing biased systems’,” Journal of medical systems, vol. 37, no. 4, pp. 1–11, 2013.
[2] M. Adil and M. K. Khan, “Emerging iot applications in sustainable
or alike papers. Initially, we limit our investigation to three smart cities for covid-19: Network security and data preservation
major research questions, where the first question was about challenges with future directions,” Sustainable Cities and Society,
the security criteria of existing HC-IoT applications, whereas vol. 75, p. 103311, 2021.
[3] M. Adil, H. Alshahrani, A. Rajab, A. Shaikh, H. Song, and A. Farouk,
Questions two and three focus on continent-wise research con- “Qos review: Smart sensing in wake of covid-19, current trends and
tribution and publishing venues and dates respectively. Firstly, specifications with future research directions,” IEEE Sensors Journal,
we addressed question one by evaluating the security criteria 2022.
[4] H. Liu, H. Ning, Q. Mu, Y. Zheng, J. Zeng, L. T. Yang, R. Huang,
of HC-IoT applications to identify the problems difficult and J. Ma, “A review of the smart world,” Future generation computer
for researchers to resolve it. Consequently, we concentrated systems, vol. 96, pp. 678–691, 2019.
on questions two and three to cover the present literature [5] S. Sarkar and S. Misra, “Theoretical modelling of fog computing: a
green computing paradigm to support iot applications,” Iet Networks,
associated with the security of HC-IoT applications. To claim vol. 5, no. 2, pp. 23–29, 2016.
the contribution of this work, we compared each section with [6] M. K. Khan, J. Zhang, and L. Tian, “Chaotic secure content-based hid-
the existing review papers in the tabular form such as TABLE den transmission of biometric templates,” Chaos, Solitons & Fractals,
vol. 32, no. 5, pp. 1749–1759, 2007.
III, V, and IX. Consequently, we discussed that how Edge [7] Z. Siddiqui, J. Gao, and M. K. Khan, “An improved lightweight puf–
computing, Fog computing, Blockchain, Machine learning, pki digital certificate authentication scheme for the internet of things,”
Deep learning, and Cryptography techniques could be helpful IEEE Internet of Things Journal, vol. 9, no. 20, pp. 19 744–19 756,
2022.
individually or collaboratively to resolve these problems and
[8] M. Adil, J. Ali, M. S. Khan, J. Kim, R. Alturki, M. Zakarya, M. Khan,
satisfy the demands of HC-IoT applications. At the end, we R. Khan, and S. M. Kim, “An intelligent hybrid mutual authentication
have underlined the possible research directions that could scheme for industrial internet of thing networks,” CMC-COMPUTERS
be used as an effective weapon against the open security MATERIALS & CONTINUA, vol. 68, no. 1, pp. 447–470, 2021.
[9] M. A. Jan, F. Khan, S. Mastorakis, M. Adil, A. Akbar, and N. Stergiou,
challenges to resolve them with the least complexities and “Lightiot: Lightweight and secure communication for energy-efficient
minimal network cost. iot in health informatics,” IEEE Transactions on Green Communica-
tions and Networking, vol. 5, no. 3, pp. 1202–1211, 2021.
[10] F. Meneghello, M. Calore, D. Zucchetto, M. Polese, and A. Zanella,
ACKNOWLEDGEMENT “Iot: Internet of threats? a survey of practical security vulnerabilities
in real iot devices,” IEEE Internet of Things Journal, vol. 6, no. 5, pp.
This work was supported in part by the Guang- 8182–8201, 2019.
dong Provincial Key Laboratory of Human Digital Twin [11] Y. A. Qadri, A. Nauman, Y. B. Zikria, A. V. Vasilakos, and S. W.
Kim, “The future of healthcare internet of things: a survey of emerging
(2022B1212010004) and the Endowed Professorship from the technologies,” IEEE Communications Surveys & Tutorials, vol. 22,
Shenzhen Holdfound Foundation and Muhammad Khurram no. 2, pp. 1121–1167, 2020.
20
[12] M. N. Bhuiyan, M. M. Rahman, M. M. Billah, and D. Saha, “Internet [34] B. Deebak and F. Al-Turjman, “Secure-user sign-in authentication for
of things (iot): a review of its enabling technologies in healthcare iot-based ehealth systems,” Complex & Intelligent Systems, pp. 1–21,
applications, standards protocols, security, and market opportunities,” 2021.
IEEE Internet of Things Journal, vol. 8, no. 13, pp. 10 474–10 498, [35] M. ADIL, “Black hole attacks prevention through mac based aodv
2021. protocol in constraint oriented networks.”
[13] F. Alshehri and G. Muhammad, “A comprehensive survey of the [36] Y. An, F. R. Yu, J. Li, J. Chen, and V. C. Leung, “Edge intelligence
internet of things (iot) and ai-based smart healthcare,” IEEE Access, (ei)-enabled http anomaly detection framework for the internet of things
vol. 9, pp. 3660–3678, 2020. (iot),” IEEE Internet of Things Journal, vol. 8, no. 5, pp. 3554–3566,
[14] Y. B. Zikria, R. Ali, M. K. Afzal, and S. W. Kim, “Next-generation 2020.
internet of things (iot): Opportunities, challenges, and solutions,” [37] S. R. Islam, D. Kwak, M. H. Kabir, M. Hossain, and K.-S. Kwak,
Sensors, vol. 21, no. 4, p. 1174, 2021. “The internet of things for health care: a comprehensive survey,” IEEE
[15] A. Raghuvanshi, U. K. Singh, and C. Joshi, “A review of various access, vol. 3, pp. 678–708, 2015.
security and privacy innovations for iot applications in healthcare,” Ad- [38] C. Esposito, A. De Santis, G. Tortora, H. Chang, and K.-K. R. Choo,
vanced Healthcare Systems: Empowering Physicians with IoT-Enabled “Blockchain: A panacea for healthcare cloud-based data security and
Technologies, pp. 43–58, 2022. privacy?” IEEE Cloud Computing, vol. 5, no. 1, pp. 31–37, 2018.
[16] R. Somasundaram and M. Thirugnanam, “Review of security chal- [39] F. Fernandez and G. C. Pallis, “Opportunities and challenges of the
lenges in healthcare internet of things,” Wireless Networks, vol. 27, internet of things for healthcare: Systems engineering perspective,” in
no. 8, pp. 5503–5509, 2021. 2014 4th international conference on wireless mobile communication
[17] C. Butpheng, K.-H. Yeh, and H. Xiong, “Security and privacy in iot- and healthcare-transforming healthcare through innovations in mobile
cloud-based e-health systems—a comprehensive review,” Symmetry, and wireless technologies (MOBIHEALTH). IEEE, 2014, pp. 263–266.
vol. 12, no. 7, p. 1191, 2020. [40] T. McGhin, K.-K. R. Choo, C. Z. Liu, and D. He, “Blockchain
[18] W. Li, Y. Chai, F. Khan, S. R. U. Jan, S. Verma, V. G. Menon, X. Li in healthcare applications: Research challenges and opportunities,”
et al., “A comprehensive survey on machine learning-based big data Journal of Network and Computer Applications, vol. 135, pp. 62–75,
analytics for iot-enabled smart healthcare system,” Mobile Networks 2019.
and Applications, vol. 26, no. 1, pp. 234–252, 2021. [41] A. Kumari, S. Tanwar, S. Tyagi, and N. Kumar, “Fog computing for
[19] V. Hassija, V. Chamola, V. Saxena, D. Jain, P. Goyal, and B. Sikdar, “A healthcare 4.0 environment: Opportunities and challenges,” Computers
survey on iot security: application areas, security threats, and solution & Electrical Engineering, vol. 72, pp. 1–13, 2018.
architectures,” IEEE Access, vol. 7, pp. 82 721–82 743, 2019. [42] M. Hartmann, U. S. Hashmi, and A. Imran, “Edge computing in
[20] R. Attarian and S. Hashemi, “An anonymity communication protocol smart health care systems: Review, challenges, and research directions,”
for security and privacy of clients in iot-based mobile health transac- Transactions on Emerging Telecommunications Technologies, vol. 33,
tions,” Computer Networks, vol. 190, p. 107976, 2021. no. 3, p. e3710, 2022.
[21] B. Kitchenham and S. Charters, “Guidelines for performing systematic [43] M. Ndiaye, S. S. Oyewobi, A. M. Abu-Mahfouz, G. P. Hancke, A. M.
literature reviews in software engineering,” 2007. Kurien, and K. Djouani, “Iot in the wake of covid-19: A survey
[22] J. Beel and B. Gipp, “Google scholar’s ranking algorithm: an intro- on contributions, challenges and evolution,” Ieee Access, vol. 8, pp.
ductory overview,” in Proceedings of the 12th international conference 186 821–186 839, 2020.
on scientometrics and informetrics (ISSI’09), vol. 1. Rio de Janeiro [44] P. P. Ray, D. Dash, and N. Kumar, “Sensors for internet of medical
(Brazil), 2009, pp. 230–241. things: State-of-the-art, security and privacy issues, challenges and
[23] S. Goyal, N. Sharma, B. Bhushan, A. Shankar, and M. Sagayam, “Iot future directions,” Computer Communications, vol. 160, pp. 111–131,
enabled technology in secured healthcare: applications, challenges and 2020.
future directions,” in Cognitive internet of medical things for smart [45] M. A. Cyran, “Blockchain as a foundation for sharing healthcare data,”
healthcare. Springer, 2021, pp. 25–48. Blockchain in Healthcare Today, 2018.
[24] K. Kaur and H. K. Verma, “The interoperability of fog and iot in [46] P. Mohamed Shakeel, S. Baskar, V. Sarma Dhulipala, S. Mishra, and
healthcare domain: Architecture, application, and challenges,” in Fog M. M. Jaber, “Maintaining security and privacy in health care system
Computing for Healthcare 4.0 Environments. Springer, 2021, pp. 535– using learning based deep-q-networks,” Journal of medical systems,
561. vol. 42, no. 10, pp. 1–10, 2018.
[25] M. Adil, R. Khan, and M. A. N. U. Ghani, “Preventive techniques of [47] E. M. Abou-Nassar, A. M. Iliyasu, P. M. El-Kafrawy, O.-Y. Song, A. K.
phishing attacks in networks,” in 2020 3rd International Conference Bashir, and A. A. Abd El-Latif, “Ditrust chain: towards blockchain-
on Advancements in Computational Sciences (ICACS). IEEE, 2020, based trust models for sustainable healthcare iot systems,” IEEE
pp. 1–8. Access, vol. 8, pp. 111 223–111 238, 2020.
[26] R. Patra, M. Bhattacharya, and S. Mukherjee, “Iot-based computational [48] Y. A. Qadri, R. Ali, A. Musaddiq, F. Al-Turjman, D. W. Kim, and S. W.
frameworks in disease prediction and healthcare management: Strate- Kim, “The limitations in the state-of-the-art counter-measures against
gies, challenges, and potential,” in IoT in Healthcare and Ambient the security threats in h-iot,” Cluster Computing, vol. 23, no. 3, pp.
Assisted Living. Springer, 2021, pp. 17–41. 2047–2065, 2020.
[27] C. Graham, “Fear of the unknown with healthcare iot devices: An [49] N. Mishra and S. Pandya, “Internet of things applications, security
exploratory study,” Information Security Journal: A Global Perspective, challenges, attacks, intrusion detection, and future visions: A systematic
vol. 30, no. 2, pp. 100–110, 2021. review,” IEEE Access, vol. 9, pp. 59 353–59 377, 2021.
[28] M. Sookhak, M. R. Jabbarpour, N. S. Safa, and F. R. Yu, “Blockchain [50] J. H. Abawajy and M. M. Hassan, “Federated internet of things and
and smart contract for access control in healthcare: a survey, issues cloud computing pervasive patient health monitoring system,” IEEE
and challenges, and open issues,” Journal of Network and Computer Communications Magazine, vol. 55, no. 1, pp. 48–53, 2017.
Applications, vol. 178, p. 102950, 2021. [51] S. R. Islam, J. Lloret, and Y. B. Zikria, “Internet of things (iot)-based
[29] C. Lesjak, T. Ruprechter, H. Bock, J. Haid, and E. Brenner, “Es- wireless health: Enabling technologies and applications,” p. 148, 2021.
tado—enabling smart services for industrial equipment through a [52] M. M. Dhanvijay and S. C. Patil, “Internet of things: A survey of
secured, transparent and ad-hoc data transmission online,” in The enabling technologies in healthcare and its applications,” Computer
9th International Conference for Internet Technology and Secured Networks, vol. 153, pp. 113–131, 2019.
Transactions (ICITST-2014). IEEE, 2014, pp. 171–177. [53] S. P. Amaraweera and M. N. Halgamuge, “Internet of things in the
[30] T. Pereira, L. Barreto, and A. Amaral, “Network and information secu- healthcare sector: overview of security and privacy issues,” Security,
rity challenges within industry 4.0 paradigm,” Procedia manufacturing, privacy and trust in the IoT environment, pp. 153–179, 2019.
vol. 13, pp. 1253–1260, 2017. [54] D. Sharma and R. Tripathi, “Performance of internet of things (iot)
[31] S. Han, M. Gu, B. Yang, J. Lin, H. Hong, and M. Kong, “A secure based healthcare secure services and its importance: Issue and chal-
trust-based key distribution with self-healing for internet of things,” lenges,” in Proceedings of the International Conference on Innovative
IEEE Access, vol. 7, pp. 114 060–114 076, 2019. Computing & Communications (ICICC), 2020.
[32] S. Xu, Y. Li, R. Deng, Y. Zhang, X. Luo, and X. Liu, “Lightweight [55] M. Adil, R. Khan, M. A. Almaiah, M. Al-Zahrani, M. Zakarya, M. S.
and expressive fine-grained access control for healthcare internet-of- Amjad, and R. Ahmed, “Mac-aodv based mutual authentication scheme
things,” IEEE Transactions on Cloud Computing, 2019. for constraint oriented networks,” IEEE Access, vol. 8, pp. 44 459–
[33] S. Rana, D. Mishra, and R. Arora, “Privacy-preserving key agreement 44 469, 2020.
protocol for fog computing supported internet of things environment,” [56] D. Preuveneers, W. Joosen, and E. Ilie-Zudor, “Data protection compli-
Wireless Personal Communications, vol. 119, no. 1, pp. 727–747, 2021. ance regulations and implications for smart factories of the future,” in
21
2016 12th International Conference on Intelligent Environments (IE). Computing; Pervasive Intelligence and Computing. IEEE, 2015, pp.
IEEE, 2016, pp. 40–47. 581–588.
[57] Z. Bakhshi, A. Balador, and J. Mustafa, “Industrial iot security threats [77] Y. Yang, X. Liu, and R. H. Deng, “Lightweight break-glass access
and concerns by considering cisco and microsoft iot reference models,” control system for healthcare internet-of-things,” IEEE Transactions
in 2018 IEEE Wireless Communications and Networking Conference on Industrial Informatics, vol. 14, no. 8, pp. 3610–3617, 2017.
Workshops (WCNCW). IEEE, 2018, pp. 173–178. [78] B. S. Egala, A. K. Pradhan, V. Badarla, and S. P. Mohanty, “Fortified-
[58] D. Conzon, M. R. A. Rashid, X. Tao, A. Soriano, R. Nicholson, and chain: a blockchain-based framework for security and privacy-assured
E. Ferrera, “Brain-iot: Model-based framework for dependable sensing internet of medical things with effective access control,” IEEE Internet
and actuation in intelligent decentralized iot systems,” in 2019 4th of Things Journal, vol. 8, no. 14, pp. 11 717–11 731, 2021.
International Conference on Computing, Communications and Security [79] J. Sun, D. Chen, N. Zhang, G. Xu, M. Tang, X. Nie, and M. Cao, “A
(ICCCS). IEEE, 2019, pp. 1–8. privacy-aware and traceable fine-grained data delivery system in cloud-
[59] M. Usman, M. A. Jan, A. Jolfaei, M. Xu, X. He, and J. Chen, “A assisted healthcare iiot,” IEEE Internet of Things Journal, vol. 8, no. 12,
distributed and anonymous data collection framework based on mul- pp. 10 034–10 046, 2021.
tilevel edge computing architecture,” IEEE Transactions on Industrial [80] Z. Lv, L. Qiao, M. S. Hossain, and B. J. Choi, “Analysis of using
Informatics, vol. 16, no. 9, pp. 6114–6123, 2019. blockchain to protect the privacy of drone big data,” IEEE network,
[60] A. Banotra, J. S. Sharma, S. Gupta, S. K. Gupta, and M. Rashid, “Use vol. 35, no. 1, pp. 44–49, 2021.
of blockchain and internet of things for securing data in healthcare [81] U. Tripathi, R. Saran, V. Chamola, A. Jolfaei, and A. Chintanpalli,
systems,” in Multimedia Security. Springer, 2021, pp. 255–267. “Advancing remote healthcare using humanoid and affective systems,”
[61] I. Ullah, N. U. Amin, M. A. Khan, H. Khattak, and S. Kumari, IEEE Sensors Journal, 2021.
“An efficient and provable secure certificate-based combined signature, [82] J. J. Kang, M. Dibaei, G. Luo, W. Yang, P. Haskell-Dowland, and
encryption and signcryption scheme for internet of things (iot) in X. Zheng, “An energy-efficient and secure data inference framework
mobile health (m-health) system,” Journal of Medical Systems, vol. 45, for internet of health things: a pilot study,” Sensors, vol. 21, no. 1, p.
no. 1, pp. 1–14, 2021. 312, 2021.
[62] A. Sharma and A. P. Bhatt, “Quantum cryptography for securing iot- [83] W. Saeed, Z. Ahmad, A. I. Jehangiri, N. Mohamed, A. I. Umar, and
based healthcare systems,” in Limitations and Future Applications of J. Ahmad, “A fault tolerant data management scheme for healthcare
Quantum Cryptography. IGI Global, 2021, pp. 124–147. internet of things in fog computing,” KSII Transactions on Internet
[63] M. Anuradha, T. Jayasankar, N. Prakash, M. Y. Sikkandar, G. Hemalak- and Information Systems (TIIS), vol. 15, no. 1, pp. 35–57, 2021.
shmi, C. Bharatiraja, and A. S. F. Britto, “Iot enabled cancer prediction [84] P. Sundaravadivel, E. Kougianos, S. P. Mohanty, and M. K. Ganap-
system to enhance the authentication and security using cloud comput- athiraju, “Everything you wanted to know about smart health care:
ing,” Microprocessors and Microsystems, vol. 80, p. 103301, 2021. Evaluating the different technologies and components of the internet
[64] M. J. Gul, B. Subramanian, A. Paul, and J. Kim, “Blockchain for public of things for better health,” IEEE Consumer Electronics Magazine,
health care in smart society,” Microprocessors and Microsystems, vol. 7, no. 1, pp. 18–28, 2017.
vol. 80, p. 103524, 2021. [85] J. J. Rodrigues, D. B. D. R. Segundo, H. A. Junqueira, M. H. Sabino,
[65] A. Tolba and Z. Al-Makhadmeh, “Predictive data analysis approach R. M. Prince, J. Al-Muhtadi, and V. H. C. De Albuquerque, “Enabling
for securing medical data in smart grid healthcare systems,” Future technologies for the internet of health things,” Ieee Access, vol. 6, pp.
Generation Computer Systems, vol. 117, pp. 87–96, 2021. 13 129–13 141, 2018.
[66] R. Al-Ali, R. Heinrich, P. Hnetynka, A. Juan-Verdejo, S. Seifermann, [86] G. Manogaran, R. Varatharajan, D. Lopez, P. M. Kumar, R. Sun-
and M. Walter, “Modeling of dynamic trust contracts for industry 4.0 darasekar, and C. Thota, “A new architecture of internet of things and
systems,” in Proceedings of the 12th European Conference on Software big data ecosystem for secured smart healthcare monitoring and alerting
Architecture: Companion Proceedings, 2018, pp. 1–4. system,” Future Generation Computer Systems, vol. 82, pp. 375–387,
[67] J. Schütte and G. S. Brost, “Lucon: Data flow control for message- 2018.
based iot systems,” in 2018 17th IEEE International Conference On [87] G. Elhayatmy, N. Dey, and A. S. Ashour, “Internet of things based
Trust, Security And Privacy In Computing And Communications/12th wireless body area network in healthcare,” in Internet of things and big
IEEE International Conference On Big Data Science And Engineering data analytics toward next-generation intelligence. Springer, 2018, pp.
(TrustCom/BigDataSE). IEEE, 2018, pp. 289–299. 3–20.
[68] H. Chi, Q. Zeng, X. Du, and L. Luo, “Pfirewall: Semantics-aware [88] H. Fu, M. Wang, P. Li, S. Jiang, W. Hu, X. Guo, and M. Cao, “Tracing
customizable data flow control for smart home privacy protection,” knowledge development trajectories of the internet of things domain:
arXiv preprint arXiv:2101.10522, 2021. A main path analysis,” IEEE Transactions on Industrial Informatics,
[69] P. W. Khan and Y. Byun, “A blockchain-based secure image encryption vol. 15, no. 12, pp. 6531–6540, 2019.
scheme for the industrial internet of things,” Entropy, vol. 22, no. 2, [89] B. Dieber and B. Breiling, “Security considerations in modular mobile
p. 175, 2020. manipulation,” in 2019 third IEEE international conference on robotic
[70] X. Rong-na, L. Hui, S. Guo-zhen, G. Yun-chuan, N. Ben, and S. Mang, computing (IRC). IEEE, 2019, pp. 70–77.
“Provenance-based data flow control mechanism for internet of things,” [90] A. K. Das, S. Zeadally, and D. He, “Taxonomy and analysis of security
Transactions on Emerging Telecommunications Technologies, vol. 32, protocols for internet of things,” Future Generation Computer Systems,
no. 5, p. e3934, 2021. vol. 89, pp. 110–125, 2018.
[71] T. Horak, P. Strelec, L. Huraj, P. Tanuska, A. Vaclavova, and M. Ke- [91] H. Klaus, F. Hetzelt, P. Hofmann, A. Blecker, and D. Schwaiger,
bisek, “The vulnerability of the production line using industrial iot “Challenges and solutions for industry-grade secure connectivity,” in
systems under ddos attack,” Electronics, vol. 10, no. 4, p. 381, 2021. 2019 International Conference on Networked Systems (NetSys). IEEE,
[72] L. Huraj, T. Horak, P. Strelec, and P. Tanuska, “Mitigation against 2019, pp. 1–5.
ddos attacks on an iot-based production line using machine learning,” [92] T. Li, H. Wang, D. He, and J. Yu, “Permissioned blockchain-based
Applied Sciences, vol. 11, no. 4, p. 1847, 2021. anonymous and traceable aggregate signature scheme for industrial
[73] X. Liu, W. Yu, F. Liang, D. Griffith, and N. Golmie, “On deep rein- internet of things,” IEEE Internet of Things Journal, vol. 8, no. 10,
forcement learning security for industrial internet of things,” Computer pp. 8387–8398, 2020.
Communications, vol. 168, pp. 20–32, 2021. [93] P. Jayalaxmi, R. Saha, G. Kumar, N. Kumar, and T.-H. Kim, “A taxon-
[74] G. Avramidis and D. Karampatzakis, “An industrial iot edge node omy of security issues in industrial internet-of-things: scoping review
for buffer level detection in a cardboard production line,” in IOP for existing solutions, future implications, and research challenges,”
Conference Series: Materials Science and Engineering, vol. 1032, IEEE Access, vol. 9, pp. 25 344–25 359, 2021.
no. 1. IOP Publishing, 2021, p. 012014. [94] K.-H. Yeh, “A secure iot-based healthcare system with body sensor
[75] A. Bicaku, C. Schmittner, M. Tauber, and J. Delsing, “Monitoring networks,” IEEE access, vol. 4, pp. 10 288–10 299, 2016.
industry 4.0 applications for security and safety standard compliance,” [95] G. Chen and W. S. Ng, “An efficient authorization framework for
in 2018 IEEE Industrial Cyber-Physical Systems (ICPS). IEEE, 2018, securing industrial internet of things,” in TENCON 2017-2017 IEEE
pp. 749–754. Region 10 Conference. IEEE, 2017, pp. 1219–1224.
[76] S. R. Moosavi, T. N. Gia, E. Nigussie, A.-M. Rahmani, S. Virtanen, [96] A. Meddeb, “Internet of things standards: who stands out from the
H. Tenhunen, and J. Isoaho, “Session resumption-based end-to-end crowd?” IEEE Communications Magazine, vol. 54, no. 7, pp. 40–47,
security for healthcare internet-of-things,” in 2015 IEEE International 2016.
Conference on Computer and Information Technology; Ubiquitous [97] C.-H. Han, “International electrotechnical commission,” Electric Engi-
Computing and Communications; Dependable, Autonomic and Secure neers Magazine, pp. 29–34, 2007.
22
[98] G. Aceto, V. Persico, and A. Pescapé, “Industry 4.0 and health: Internet in 2019 International Conference on Wireless and Mobile Computing,
of things, big data, and cloud computing for healthcare 4.0,” Journal Networking and Communications (WiMob). IEEE, 2019, pp. 1–6.
of Industrial Information Integration, vol. 18, p. 100129, 2020. [119] B. Craggs, A. Rashid, C. Hankin, R. Antrobus, O. Şerban, and
[99] A. Tewari and B. B. Gupta, “Security, privacy and trust of different lay- N. Thapen, “A reference architecture for iiot and industrial control
ers in internet-of-things (iots) framework,” Future generation computer systems testbeds,” in Living in the Internet of Things (IoT 2019). IET,
systems, vol. 108, pp. 909–920, 2020. 2019, pp. 1–8.
[100] P. Panchatcharam and S. Vivekanandan, “Internet of things (iot) in [120] R. A. Isbell, C. Maple, B. Hallaq, and H. Boyes, “Development of
healthcare–smart health and surveillance, architectures, security anal- a capability maturity model for cyber security in iiot enabled supply
ysis and data transfer: a review,” International Journal of Software chains,” 2019.
Innovation (IJSI), vol. 7, no. 2, pp. 21–40, 2019. [121] J. M. Mcginthy and A. J. Michaels, “Secure industrial internet of things
[101] P. M. Kumar and U. D. Gandhi, “Enhanced dtls with coap-based au- critical infrastructure node design,” IEEE Internet of Things Journal,
thentication scheme for the internet of things in healthcare application,” vol. 6, no. 5, pp. 8021–8037, 2019.
The Journal of Supercomputing, vol. 76, no. 6, pp. 3963–3983, 2020. [122] A. Bécue, Y. Fourastier, I. Praça, A. Savarit, C. Baron, B. Gradussofs,
[102] M. E. S. Saeed, Q.-Y. Liu, G. Tian, B. Gao, and F. Li, “Remote E. Pouille, and C. Thomas, “Cyberfactory# 1—securing the industry 4.0
authentication schemes for wireless body area networks based on the with cyber-ranges and digital twins,” in 2018 14th IEEE International
internet of things,” IEEE Internet of Things Journal, vol. 5, no. 6, pp. Workshop on Factory Communication Systems (WFCS). IEEE, 2018,
4926–4944, 2018. pp. 1–4.
[103] B. Leander, A. Čaušević, and H. Hansson, “Applicability of the iec [123] P. K. Dhillon and S. Kalra, “Multi-factor user authentication scheme
62443 standard in industry 4.0/iiot,” in Proceedings of the 14th Inter- for iot-based healthcare services,” Journal of Reliable Intelligent Envi-
national Conference on Availability, Reliability and Security, 2019, pp. ronments, vol. 4, no. 3, pp. 141–160, 2018.
1–8. [124] K. Tange, M. De Donno, X. Fafoutis, and N. Dragoni, “A systematic
[104] A. Mosenia and N. K. Jha, “A comprehensive study of security of survey of industrial internet of things security: Requirements and fog
internet-of-things,” IEEE Transactions on emerging topics in comput- computing opportunities,” IEEE Communications Surveys & Tutorials,
ing, vol. 5, no. 4, pp. 586–602, 2016. vol. 22, no. 4, pp. 2489–2520, 2020.
[105] Z. Liao, S. Nazir, H. U. Khan, and M. Shafiq, “Assessing security of [125] A. Laszka, W. Abbas, Y. Vorobeychik, and X. Koutsoukos, “Synergistic
software components for internet of things: a systematic review and security for the industrial internet of things: Integrating redundancy,
future directions,” Security and Communication Networks, vol. 2021, diversity, and hardening,” in 2018 IEEE International Conference on
2021. Industrial Internet (ICII). IEEE, 2018, pp. 153–158.
[106] S. Bhatt, P. R. Ragiri et al., “Security trends in internet of things: A [126] E. T. Nakamura and S. L. Ribeiro, “A privacy, security, safety, resilience
survey,” SN Applied Sciences, vol. 3, no. 1, pp. 1–14, 2021. and reliability focused risk assessment methodology for iiot systems
[107] N. Alhirabi, O. Rana, and C. Perera, “Security and privacy requirements steps to build and use secure iiot systems,” in 2018 Global Internet of
for the internet of things: A survey,” ACM Transactions on Internet of Things Summit (GIoTS). IEEE, 2018, pp. 1–6.
Things, vol. 2, no. 1, pp. 1–37, 2021.
[127] H. Mouratidis and V. Diamantopoulou, “A security analysis method
[108] L. Sanneman, C. Fourie, J. A. Shah et al., “The state of industrial
for industrial internet of things,” IEEE Transactions on Industrial
robotics: Emerging technologies, challenges, and key research direc-
Informatics, vol. 14, no. 9, pp. 4093–4100, 2018.
tions,” Foundations and Trends® in Robotics, vol. 8, no. 3, pp. 225–
[128] H. Boyes, B. Hallaq, J. Cunningham, and T. Watson, “The industrial in-
306, 2021.
ternet of things (iiot): An analysis framework,” Computers in industry,
[109] V. Nigam and C. Talcott, “Formal security verification of industry
vol. 101, pp. 1–12, 2018.
4.0 applications,” in 2019 24th IEEE International Conference on
[129] I. Ivkic, A. Mauthe, and M. Tauber, “Towards a security cost model
Emerging Technologies and Factory Automation (ETFA). IEEE, 2019,
for cyber-physical systems,” in 2019 16th IEEE Annual Consumer
pp. 1043–1050.
Communications & Networking Conference (CCNC). IEEE, 2019,
[110] A. Srivastava, P. Jain, B. Hazela, P. Asthana, and S. W. A. Rizvi,
pp. 1–7.
“Application of fog computing, internet of things, and blockchain
technology in healthcare industry,” in Fog Computing for Healthcare [130] E. O. Yeboah-Boateng, Cyber-Security Challenges with SMEs in De-
4.0 Environments. Springer, 2021, pp. 563–591. veloping Economies: Issues of Confidentiality, Integrity & Availability
[111] S. Doss, J. Paranthaman, S. Gopalakrishnan, A. Duraisamy, S. Pal, (CIA). Institut for Elektroniske Systemer, Aalborg Universitet, 2013.
B. Duraisamy, and D. Le, “Memetic optimization with cryptographic [131] A. Bicaku, S. Maksuti, S. Palkovits-Rauter, M. Tauber, R. Matischek,
encryption for secure medical data transmission in iot-based distributed C. Schmittner, G. Mantas, M. Thron, and J. Delsing, “Towards trust-
systems,” Computers, Materials & Continua, vol. 66, no. 2, pp. 1577– worthy end-to-end communication in industry 4.0,” in 2017 IEEE 15th
1594, 2021. International Conference on Industrial Informatics (INDIN). IEEE,
[112] Y. Zhang, Y. Sun, R. Jin, K. Lin, and W. Liu, “High-performance 2017, pp. 889–896.
isolation computing technology for smart iot healthcare in cloud [132] S. Banupriya, K. Kottursamy, and A. K. Bashir, “Privacy-preserving
environments,” IEEE Internet of Things Journal, vol. 8, no. 23, pp. hierarchical deterministic key generation based on a lattice of rings in
16 872–16 879, 2021. public blockchain,” Peer-to-Peer Networking and Applications, vol. 14,
[113] J. Huang, X. Wu, W. Huang, and X. Wu, “Design of a data management no. 5, pp. 2813–2825, 2021.
system for medical internet of things based on mobile platform,” [133] V. Sklyar and V. Kharchenko, “Challenges in assurance case application
Journal of Ambient Intelligence and Humanized Computing, pp. 1–13, for industrial iot,” in 2017 9th IEEE international conference on intel-
2021. ligent data acquisition and advanced computing systems: technology
[114] J. Ali, B.-h. Roh, B. Lee, J. Oh, and M. Adil, “A machine learning and applications (IDAACS), vol. 2. IEEE, 2017, pp. 736–739.
framework for prevention of software-defined networking controller [134] R. Khan, J. Teo, M. A. Jan, S. Verma, R. Alturki, and A. Ghani, “A
from ddos attacks and dimensionality reduction of big data,” in 2020 trustworthy, reliable and lightweight privacy and data integrity approach
International Conference on Information and Communication Technol- for the internet of things,” IEEE Transactions on Industrial Informatics,
ogy Convergence (ICTC). IEEE, 2020, pp. 515–519. 2022.
[115] G. Shaabany and R. Anderl, “Security by design as an approach to [135] N. Kammoun, A. ben Chehida Douss, R. Abassi, and S. Guemara el
design a secure industry 4.0-capable machine enabling online-trading of Fatmi, “Ensuring data integrity using digital signature in an iot
technology data,” in 2018 International Conference on System Science environment,” in International Conference on Advanced Information
and Engineering (ICSSE). IEEE, 2018, pp. 1–5. Networking and Applications. Springer, 2022, pp. 482–491.
[116] M. Eckhart, A. Ekelhart, A. Lüder, S. Biffl, and E. Weippl, “Secu- [136] E. Weippl and P. Kieseberg, “Security in cyber-physical production
rity development lifecycle for cyber-physical production systems,” in systems: A roadmap to improving it-security in the production system
IECON 2019-45th Annual Conference of the IEEE Industrial Electron- lifecycle,” in 2017 AEIT international annual conference. IEEE, 2017,
ics Society, vol. 1. IEEE, 2019, pp. 3004–3011. pp. 1–6.
[117] S. Maksuti, A. Bicaku, M. Tauber, S. Palkovits-Rauter, S. Haas, and [137] M. A. Ferrag, L. A. Maglaras, H. Janicke, J. Jiang, and L. Shu, “Au-
J. Delsing, “Towards flexible and secure end-to-end communication in thentication protocols for internet of things: a comprehensive survey,”
industry 4.0,” in 2017 IEEE 15th international conference on industrial Security and Communication Networks, vol. 2017, 2017.
informatics (INDIN). IEEE, 2017, pp. 883–888. [138] D. Wang and P. Wang, “On the anonymity of two-factor authentication
[118] H. Aranha, M. Masi, T. Pavleska, and G. P. Sellitto, “Securing mobile schemes for wireless sensor networks: Attacks, principle and solutions,”
e-health environments by design: A holistic architectural approach,” Computer Networks, vol. 73, pp. 41–57, 2014.
23
[139] U. Hunkeler, H. L. Truong, and A. Stanford-Clark, “Mqtt-s—a pub- on radio frequency fingerprint,” IEEE Internet of Things Journal, vol. 6,
lish/subscribe protocol for wireless sensor networks,” in 2008 3rd no. 5, pp. 7980–7987, 2019.
International Conference on Communication Systems Software and [159] B. Hu, W. Tang, and Q. Xie, “A two-factor security authentication
Middleware and Workshops (COMSWARE’08). IEEE, 2008, pp. 791– scheme for wireless sensor networks in iot environments,” Neurocom-
798. puting, 2022.
[140] S. Katsikeas, K. Fysarakis, A. Miaoudakis, A. Van Bemten, I. Askoxy- [160] S. Hussain and S. A. Chaudhry, “Comments on “biometrics-based
lakis, I. Papaefstathiou, and A. Plemenos, “Lightweight & secure privacy-preserving user authentication scheme for cloud-based indus-
industrial iot communications via the mq telemetry transport protocol,” trial internet of things deployment”,” IEEE Internet of Things Journal,
in 2017 IEEE Symposium on Computers and Communications (ISCC). vol. 6, no. 6, pp. 10 936–10 940, 2019.
IEEE, 2017, pp. 1193–1200. [161] X. Li, J. Niu, M. Z. A. Bhuiyan, F. Wu, M. Karuppiah, and S. Kumari,
[141] N. A. Hussein and M. I. Shujaa, “Dna computing based stream cipher “A robust ecc-based provable secure authentication protocol with
for internet of things using mqtt protocol,” International Journal of privacy preserving for industrial internet of things,” IEEE Transactions
Electrical and Computer Engineering, vol. 10, no. 1, p. 1035, 2020. on Industrial Informatics, vol. 14, no. 8, pp. 3599–3609, 2017.
[142] B. Mburano and W. Si, “Evaluation of web vulnerability scanners [162] V. Puri, A. Kataria, and V. Sharma, “Artificial intelligence-powered
based on owasp benchmark,” in 2018 26th International Conference decentralized framework for internet of things in healthcare 4.0,”
on Systems Engineering (ICSEng). IEEE, 2018, pp. 1–6. Transactions on Emerging Telecommunications Technologies, p. e4245,
[143] S. S. Sahoo, S. Mohanty, and B. Majhi, “A secure three factor 2021.
based authentication scheme for health care systems using iot enabled [163] R. Dantu, I. Dissanayake, and S. Nerur, “Exploratory analysis of
devices,” Journal of Ambient Intelligence and Humanized Computing, internet of things (iot) in healthcare: a topic modelling & co-citation
vol. 12, no. 1, pp. 1419–1434, 2021. approaches,” Information Systems Management, vol. 38, no. 1, pp. 62–
[144] J.-L. Hou and K.-H. Yeh, “Novel authentication schemes for iot 78, 2021.
based healthcare systems,” International Journal of Distributed Sensor [164] M. Zhao, Y. Ding, Q. Wu, Y. Wang, B. Qin, and K. Fan, “Privacy-
Networks, vol. 11, no. 11, p. 183659, 2015. preserving lightweight data monitoring in internet of things environ-
[145] M. Ambrosin, A. Anzanpour, M. Conti, T. Dargahi, S. R. Moosavi, ments,” Wireless Personal Communications, vol. 116, no. 3, pp. 1765–
A. M. Rahmani, and P. Liljeberg, “On the feasibility of attribute-based 1783, 2021.
encryption on internet of things devices,” IEEE Micro, vol. 36, no. 6, [165] Z. Guan, X. Zhou, P. Liu, L. Wu, and W. Yang, “A blockchain based
pp. 25–35, 2016. dual side privacy preserving multi party computation scheme for edge
[146] P. K. Dhillon and S. Kalra, “A secure multi-factor ecc based authen- enabled smart grid,” IEEE Internet of Things Journal, 2021.
tication scheme for cloud-iot based healthcare services,” Journal of [166] Z. Ma, Y. Yang, X. Liu, Y. Liu, S. Ma, K. Ren, and C. Yao, “Emir-auth:
Ambient Intelligence and Smart Environments, vol. 11, no. 2, pp. 149– eye movement and iris-based portable remote authentication for smart
164, 2019. grid,” IEEE Transactions on Industrial Informatics, vol. 16, no. 10, pp.
[147] S. Roy, S. Chatterjee, A. K. Das, S. Chattopadhyay, S. Kumari, and 6597–6606, 2019.
M. Jo, “Chaotic map-based anonymous user authentication scheme
[167] F. Fraile, T. Tagawa, R. Poler, and A. Ortiz, “Trustworthy industrial iot
with user biometrics and fuzzy extractor for crowdsourcing internet
gateways for interoperability platforms and ecosystems,” IEEE Internet
of things,” IEEE Internet of Things Journal, vol. 5, no. 4, pp. 2884–
of Things Journal, vol. 5, no. 6, pp. 4506–4514, 2018.
2895, 2017.
[168] R. Ankele, S. Marksteiner, K. Nahrgang, and H. Vallant, “Requirements
[148] S. Shamshad, K. Mahmood, and S. Kumari, “Comments on “a multi-
and recommendations for iot/iiot models to automate security assurance
factor user authentication and key agreement protocol based on bilinear
through threat modelling, security analysis and penetration testing,”
pairing for the internet of things”,” Wireless Personal Communications,
in Proceedings of the 14th International Conference on Availability,
vol. 112, no. 1, pp. 463–466, 2020.
Reliability and Security, 2019, pp. 1–8.
[149] A. A. Ahmed and W. A. Ahmed, “An effective multifactor authentica-
tion mechanism based on combiners of hash function over internet of [169] Y. Zhang, R. H. Deng, G. Han, and D. Zheng, “Secure smart health with
things,” Sensors, vol. 19, no. 17, p. 3663, 2019. privacy-aware aggregate authentication and access control in internet
of things,” Journal of Network and Computer Applications, vol. 123,
[150] F. Wu, X. Li, A. K. Sangaiah, L. Xu, S. Kumari, L. Wu, and
pp. 89–100, 2018.
J. Shen, “A lightweight and robust two-factor authentication scheme
for personalized healthcare systems using wireless medical sensor [170] A. Lizardo, R. Barbosa, S. Neves, J. Correia, and F. Araujo, “End-to-
networks,” Future Generation Computer Systems, vol. 82, pp. 727– end secure group communication for the internet of things,” Journal
737, 2018. of Information Security and Applications, vol. 58, p. 102772, 2021.
[151] M. Fotouhi, M. Bayat, A. K. Das, H. A. N. Far, S. M. Pournaghi, and [171] A. Manzoor, A. Braeken, S. S. Kanhere, M. Ylianttila, and M. Liyan-
M.-A. Doostari, “A lightweight and secure two-factor authentication age, “Proxy re-encryption enabled secure and anonymous iot data shar-
scheme for wireless body area networks in health-care iot,” Computer ing platform based on blockchain,” Journal of Network and Computer
Networks, vol. 177, p. 107333, 2020. Applications, vol. 176, p. 102917, 2021.
[152] B. K. Mohanta, A. Sahoo, S. Patel, S. S. Panda, D. Jena, and [172] M. Almulhim and N. Zaman, “Proposing secure and lightweight
D. Gountia, “Decauth: Decentralized authentication scheme for iot authentication scheme for iot based e-health applications,” in 2018
device using ethereum blockchain,” in TENCON 2019-2019 IEEE 20th International Conference on advanced communication technology
Region 10 Conference (TENCON). IEEE, 2019, pp. 558–563. (ICACT). IEEE, 2018, pp. 481–487.
[153] S. Garg, K. Kaur, G. Kaddoum, and K.-K. R. Choo, “Toward secure [173] F. Rezaeibagha, Y. Mu, X. Huang, W. Yang, and K. Huang, “Fully
and provable authentication for internet of things: Realizing industry secure lightweight certificateless signature scheme for iiot,” IEEE
4.0,” IEEE Internet of Things Journal, vol. 7, no. 5, pp. 4598–4606, Access, vol. 7, pp. 144 433–144 443, 2019.
2019. [174] Q. Zhang, Y. Zhang, C. Li, C. Yan, Y. Duan, and H. Wang, “Sport
[154] D. Singh, B. Kumar, S. Singh, and S. Chand, “A secure iot-based location-based user clustering with privacy-preservation in wireless iot-
mutual authentication for healthcare applications in wireless sensor driven healthcare,” IEEE Access, vol. 9, pp. 12 906–12 913, 2021.
networks using ecc,” International Journal of Healthcare Information [175] M. N. Aman, M. H. Basheer, S. Dash, J. W. Wong, J. Xu, H. W. Lim,
Systems and Informatics (IJHISI), vol. 16, no. 2, pp. 21–48, 2021. and B. Sikdar, “Hatt: Hybrid remote attestation for the internet of things
[155] H. Khemissa and D. Tandjaoui, “A lightweight authentication scheme with high availability,” IEEE Internet of Things Journal, vol. 7, no. 8,
for e-health applications in the context of internet of things,” in 2015 pp. 7220–7233, 2020.
9th International Conference on Next Generation Mobile Applications, [176] S. F. J. J. Ankergård, E. Dushku, and N. Dragoni, “State-of-the-art
Services and Technologies. IEEE, 2015, pp. 90–95. software-based remote attestation: Opportunities and open issues for
[156] F. Al-Turjman and S. Alturjman, “Context-sensitive access in industrial internet of things,” Sensors, vol. 21, no. 5, p. 1598, 2021.
internet of things (iiot) healthcare applications,” IEEE Transactions on [177] Z. Ren, X. Li, S. Xu, and Y. Tong, “Restricting the number of times
Industrial Informatics, vol. 14, no. 6, pp. 2736–2744, 2018. that data can be accessed in cloud storage using trustzone,” in 2022
[157] M. Loske, L. Rothe, and D. G. Gertler, “Context-aware authentication: 22nd IEEE International Symposium on Cluster, Cloud and Internet
State-of-the-art evaluation and adaption to the iiot,” in 2019 IEEE 5th Computing (CCGrid). IEEE, 2022, pp. 289–296.
World Forum on Internet of Things (WF-IoT). IEEE, 2019, pp. 64–69. [178] H. Yoon and M. Lee, “Sgxdump: A repeatable code-reuse attack for
[158] Q. Tian, Y. Lin, X. Guo, J. Wen, Y. Fang, J. Rodriguez, and S. Mumtaz, extracting sgx enclave memory,” Applied Sciences, vol. 12, no. 15, p.
“New security mechanisms of high-reliability iot communication based 7655, 2022.
24
[179] R. V. O’Connor, “The iso/iec 29110 software lifecycle standard for very [200] A. B. Pawar and S. Ghumbre, “A survey on iot applications, security
small companies,” in Research Anthology on Agile Software, Software challenges and counter measures,” in 2016 international conference on
Development, and Testing. IGI Global, 2022, pp. 1884–1901. computing, analytics and security trends (CAST). IEEE, 2016, pp.
[180] S. P. Rao, G. Limonta, and J. Lindqvist, “Usability and security 294–299.
of trusted platform module ({{{{{TPM}}}}}) library {APIs},” in [201] K. K. Kolluru, C. Paniagua, J. van Deventer, J. Eliasson, J. Delsing,
Eighteenth Symposium on Usable Privacy and Security (SOUPS 2022), and R. J. DeLong, “An aaa solution for securing industrial iot devices
2022, pp. 213–232. using next generation access control,” in 2018 IEEE Industrial Cyber-
[181] H. Tan, G. Tsudik, and S. Jha, “Mtra: Multiple-tier remote attestation Physical Systems (ICPS). IEEE, 2018, pp. 737–742.
in iot networks,” in 2017 IEEE Conference on Communications and [202] M. Aloqaily, O. Bouachir, A. Boukerche, and I. Al Ridhawi, “Design
Network Security (CNS). IEEE, 2017, pp. 1–9. guidelines for blockchain-assisted 5g-uav networks,” IEEE network,
[182] M. Ammar, M. Washha, G. S. Ramabhadran, and B. Crispo, “slimiot: vol. 35, no. 1, pp. 64–71, 2021.
Scalable lightweight attestation protocol for the internet of things,” in [203] Y. Liao, E. d. F. R. Loures, and F. Deschamps, “Industrial internet of
2018 IEEE Conference on Dependable and Secure Computing (DSC). things: A systematic literature review and insights,” IEEE Internet of
IEEE, 2018, pp. 1–8. Things Journal, vol. 5, no. 6, pp. 4515–4525, 2018.
[183] S. Sidhu, B. J. Mohd, and T. Hayajneh, “Hardware security in iot [204] E. Benkhelifa, T. Welsh, and W. Hamouda, “A critical review of
devices with emphasis on hardware trojans,” Journal of Sensor and practices and challenges in intrusion detection systems for iot: Toward
Actuator Networks, vol. 8, no. 3, p. 42, 2019. universal and resilient systems,” IEEE Communications Surveys &
[184] H. Cui, R. H. Deng, J. K. Liu, X. Yi, and Y. Li, “Server-aided attribute- Tutorials, vol. 20, no. 4, pp. 3496–3509, 2018.
based signature with revocation for resource-constrained industrial- [205] R. F. Babiceanu and R. Seker, “Cyber resilience protection for in-
internet-of-things devices,” IEEE Transactions on Industrial Informat- dustrial internet of things: A software-defined networking approach,”
ics, vol. 14, no. 8, pp. 3724–3732, 2018. Computers in industry, vol. 104, pp. 47–58, 2019.
[185] M. U. Hassan, M. H. Rehmani, and J. Chen, “Privacy preservation in [206] P. C. M. Arachchige, P. Bertok, I. Khalil, D. Liu, S. Camtepe, and
blockchain based iot systems: Integration issues, prospects, challenges, M. Atiquzzaman, “A trustworthy privacy preserving framework for
and future research directions,” Future Generation Computer Systems, machine learning in industrial iot systems,” IEEE Transactions on
vol. 97, pp. 512–529, 2019. Industrial Informatics, vol. 16, no. 9, pp. 6092–6102, 2020.
[186] F. Li, J. Hong, and A. A. Omala, “Efficient certificateless access control [207] S. S. Kushwaha, S. Joshi, D. Singh, M. Kaur, and H.-N. Lee, “Sys-
for industrial internet of things,” Future Generation Computer Systems, tematic review of security vulnerabilities in ethereum blockchain smart
vol. 76, pp. 285–292, 2017. contract,” IEEE Access, 2022.
[187] C. Lin, D. He, X. Huang, K.-K. R. Choo, and A. V. Vasilakos, [208] M. Shokry, A. I. Awad, M. K. Abd-Ellah, and A. A. Khalaf, “System-
“Bsein: A blockchain-based secure mutual authentication with fine- atic survey of advanced metering infrastructure security: Vulnerabili-
grained access control system for industry 4.0,” Journal of network ties, attacks, countermeasures, and future vision,” Future Generation
and computer applications, vol. 116, pp. 42–52, 2018. Computer Systems, 2022.
[188] A. I. Abdi, F. E. Eassa, K. Jambi, K. Almarhabi, M. Khemakhem,
[209] I. Bohé, M. Willocx, and V. Naessens, “Smiot: a software architecture
A. Basuhail, and M. Yamin, “Hierarchical blockchain-based multi-
for maintainable internet-of-things applications,” International Journal
chaincode access control for securing iot systems,” Electronics, vol. 11,
of Cloud Computing, vol. 9, no. 1, pp. 75–94, 2020.
no. 5, p. 711, 2022.
[210] G. George and S. M. Thampi, “A graph-based security framework for
[189] K. Pallavi and V. Ravi Kumar, “Authentication-based access control
securing industrial iot networks from vulnerability exploitations,” IEEE
and data exchanging mechanism of iot devices in fog computing
Access, vol. 6, pp. 43 586–43 601, 2018.
environment,” Wireless Personal Communications, vol. 116, no. 4, pp.
3039–3060, 2021. [211] G. Yadav and K. Paul, “Patchrank: Ordering updates for scada sys-
tems,” in 2019 24th IEEE International Conference on Emerging
[190] X. Yao, H. Kong, H. Liu, T. Qiu, and H. Ning, “An attribute credential
Technologies and Factory Automation (ETFA). IEEE, 2019, pp. 110–
based public key scheme for fog computing in digital manufacturing,”
117.
IEEE Transactions on Industrial Informatics, vol. 15, no. 4, pp. 2297–
2307, 2019. [212] A. Seitz, D. Henze, D. Miehle, B. Bruegge, J. Nickles, and M. Sauer,
[191] Y. Kim, Y. Lee, and J. Kim, “Ripple: Adaptive fine-grained access “Fog computing as enabler for blockchain-based iiot app marketplaces-
control in multi-hop llns,” in 2018 International Conference on Infor- a case study,” in 2018 Fifth international conference on internet of
mation Networking (ICOIN). IEEE, 2018, pp. 863–868. things: systems, management and security. IEEE, 2018, pp. 182–188.
[192] F. Loukil, C. Ghedira-Guegan, K. Boukadi, A.-N. Benharkat, and [213] K. Sowjanya, M. Dasgupta, and S. Ray, “Elliptic curve cryptography
E. Benkhelifa, “Data privacy based on iot device behavior control using based authentication scheme for internet of medical things,” Journal of
blockchain,” ACM Transactions on Internet Technology (TOIT), vol. 21, Information Security and Applications, vol. 58, p. 102761, 2021.
no. 1, pp. 1–20, 2021. [214] M. A. Khan, M. T. Quasim, N. S. Alghamdi, and M. Y. Khan, “A secure
[193] M. Adil, M. Attique, M. M. Jadoon, J. Ali, A. Farouk, and H. Song, framework for authentication and encryption using improved ecc for
“Hopctp: a robust channel categorization data preservation scheme iot-based medical sensor data,” IEEE Access, vol. 8, pp. 52 018–52 027,
for industrial healthcare internet of things,” IEEE Transactions on 2020.
Industrial Informatics, vol. 18, no. 10, pp. 7151–7161, 2022. [215] H. Tao, M. Z. A. Bhuiyan, A. N. Abdalla, M. M. Hassan, J. M. Zain,
[194] N. Abd El-mawla, M. Badawy, and H. Arafat, “Security and key and T. Hayajneh, “Secured data collection with hardware-based ciphers
management challenges over wsn (a survey),” Int. J. Comput. Sci. Eng. for iot-based healthcare,” IEEE Internet of Things Journal, vol. 6, no. 1,
Surv., vol. 10, no. 01, pp. 15–34, 2019. pp. 410–420, 2018.
[195] G. Mehmood, M. S. Khan, A. Waheed, M. Zareei, M. Fayaz, T. Sadad, [216] P. Gope, Y. Gheraibia, S. Kabir, and B. Sikdar, “A secure iot-based
N. Kama, and A. Azmi, “An efficient and secure session key manage- modern healthcare system with fault-tolerant decision making process,”
ment scheme in wireless sensor network,” Complexity, vol. 2021, 2021. IEEE Journal of Biomedical and Health Informatics, vol. 25, no. 3, pp.
[196] A. Rghioui, A. L’aarje, F. Elouaai, and M. Bouhorma, “The internet 862–873, 2020.
of things for healthcare monitoring: security review and proposed [217] M. M. Hasan and H. T. Mouftah, “Cloud-centric collaborative secu-
solution,” in 2014 Third IEEE international colloquium in information rity service placement for advanced metering infrastructures,” IEEE
science and technology (CIST). IEEE, 2014, pp. 384–389. Transactions on Smart Grid, vol. 10, no. 2, pp. 1339–1348, 2017.
[197] M. Ma, G. Shi, and F. Li, “Privacy-oriented blockchain-based dis- [218] G. Settanni, F. Skopik, A. Karaj, M. Wurzenberger, and R. Fiedler,
tributed key management architecture for hierarchical access control “Protecting cyber physical production systems using anomaly detection
in the iot scenario,” IEEE access, vol. 7, pp. 34 045–34 059, 2019. to enable self-adaptation,” in 2018 IEEE Industrial Cyber-Physical
[198] S. Pamarthi and R. Narmadha, “Adaptive key management-based cryp- Systems (ICPS). IEEE, 2018, pp. 173–180.
tographic algorithm for privacy preservation in wireless mobile adhoc [219] V. Deshpande, L. George, and H. Badis, “Pulsec: Secure element
networks for iot applications,” Wireless Personal Communications, vol. based framework for sensors anomaly detection in industry 4.0,” IFAC-
124, no. 1, pp. 349–376, 2022. PapersOnLine, vol. 52, no. 13, pp. 1204–1209, 2019.
[199] S. S. Panda, D. Jena, B. K. Mohanta, S. Ramasubbareddy, M. Danesh- [220] G. Marchetto, R. Sisto, J. Yusupov, and A. Ksentinit, “Formally verified
mand, and A. H. Gandomi, “Authentication and key management in latency-aware vnf placement in industrial internet of things,” in 2018
distributed iot using blockchain technology,” IEEE Internet of Things 14th IEEE International Workshop on Factory Communication Systems
Journal, vol. 8, no. 16, pp. 12 947–12 954, 2021. (WFCS). IEEE, 2018, pp. 1–9.
25
[221] P. Hu, “A system architecture for software-defined industrial internet of [243] P. P. Ray, D. Dash, and D. De, “Edge computing for internet of things:
things,” in 2015 IEEE International Conference on Ubiquitous Wireless A survey, e-healthcare case study and future direction,” Journal of
Broadband (ICUWB). IEEE, 2015, pp. 1–5. Network and Computer Applications, vol. 140, pp. 1–22, 2019.
[222] M. Adil, M. K. Khan, A. Farouk, M. A. Jan, A. Anwar, and Z. Jin, “Ai-
driven eec for healthcare iot: Security challenges and future research
Muhammad Adil (Member, IEEE) is currently a
directions,” IEEE Consumer Electronics Magazine, 2022.
PhD student in the Department of Computer Science
[223] N. Wang, P. Wang, A. Alipour-Fanid, L. Jiao, and K. Zeng, “Physical-
and Engineering at the University at Buffalo, The
layer security of 5g wireless networks for iot: Challenges and opportu-
State University of New York, USA. He received
nities,” IEEE Internet of Things Journal, vol. 6, no. 5, pp. 8169–8181,
the Chair’s Fellowship from the department in 2022.
2019.
He received his BS and MS degrees in Computer
[224] K. Cao, H. Ding, B. Wang, L. Lv, J. Tian, Q. Wei, and F. Gong, Science from the Virtual University of Lahore, Pak-
“Enhancing physical-layer security for iot with nonorthogonal multiple istan, in 2017 and 2020 respectively. He has CCNA
access assisted semi-grant-free transmission,” IEEE Internet of Things and CCNP certifications. Mr. Adil’s research interest
Journal, vol. 9, no. 24, pp. 24 669–24 681, 2022. includes Networking, Cybersecurity, Cyber-Physical
[225] H. Sharma and N. Kumar, “Deep learning based physical layer security Systems (CPS), Unnamed Aerial Vehicles (UAVs),
for terrestrial communications in 5g and beyond networks: A survey,” Internet-of-Things (IoT), Wireless Sensor Networks (WSN). He has many
Physical Communication, p. 102002, 2023. publications in prestigious journals such as IEEE Internet of Things, IEEE
[226] P. K. Sadhu, V. P. Yanambaka, and A. Abdelgawad, “Internet of things: Transactions of Intelligent Transportation, IEEE Transactions on Industrial
Security and solutions survey,” Sensors, vol. 22, no. 19, p. 7433, 2022. Informatics, IEEE Transactions on Network Science and Engineering, IEEE
[227] P. Kumari and A. K. Jain, “A comprehensive study of ddos attacks Sensor Journal, IEEE Access, IEEE Micro Magazine, ACM Transactions
over iot network and their countermeasures,” Computers & Security, on Sensor Networks, Computer Networks Elsevier, Sustainable Cities and
p. 103096, 2023. Societies, MDPI Sensor, and many more. In addition, he is member of IEEE
[228] G. Nebbione and M. C. Calzarossa, “Security of iot application layer computer society, IEEE Industrial Electronics, IEEE Cybersecurity, IEEE
protocols: Challenges and findings,” Future Internet, vol. 12, no. 3, Young professionals, and London Journal Press Club-UK, as an Honory
p. 55, 2020. member. He is reviewing for prestigious journals, such as IEEE IoTJ, IEEE
[229] V. Amande, K. Kaur, S. Garg, and M. Guizani, “Lasua: A lightweight Sensors, IEEE Systems, IEEE TII, IEEE TCCN, IEEE TITS, IEEE TGCN,
authentication scheme with user anonymity for iot-enabled mobile IEEE WCL, IEEE Communication Magazine, IET Communication, Computer
cloud,” in GLOBECOM 2022-2022 IEEE Global Communications Networks Elsevier Journals, and Telecommunication System, etc.
Conference. IEEE, 2022, pp. 3563–3568.
[230] M. Wazid, A. K. Das, and S. Shetty, “Tacas-iot: Trust aggregation
Muhammad Khurram Khan (M’07-SM’12) is
certificate-based authentication scheme for edge-enabled iot systems,”
currently working as a full professor at the Center
IEEE Internet of Things Journal, vol. 9, no. 22, pp. 22 643–22 656,
of Excellence in Information Assurance, King Saud
2022.
University, Saudi Arabia. He has edited seven books
[231] A. N. Bahache, N. Chikouche, and F. Mezrag, “Authentication schemes and proceedings published by Springer-Verlag and
for healthcare applications using wireless medical sensor networks: A IEEE. He has published more than 400 papers in
survey,” SN Computer Science, vol. 3, no. 5, p. 382, 2022. international journals and conferences and he is an
[232] V. Singh and C. Kant, “Biometric-based authentication in internet inventor of several U.S./PCT patents. Dr. Khan is the
of things (iot): A review,” Advances in Information Communication Editor-in-Chief of a well-reputed journal ‘Telecom-
Technology and Computing: Proceedings of AICTC 2021, pp. 309– munication Systems’ (Springer). He is a full-time
317, 2022. Editor/Associate Editor of several international jour-
[233] A. Kumar, R. Saha, M. Conti, G. Kumar, W. J. Buchanan, and T. H. nals/magazines, including IEEE Communications Surveys & Tutorials, IEEE
Kim, “A comprehensive survey of authentication methods in internet- Communications Magazine, IEEE Internet of Things Journal,IEEE Trans-
of-things and its conjunctions,” Journal of Network and Computer actions on Consumer Electronics, Journal of Network & Computer Ap-
Applications, vol. 204, p. 103414, 2022. plications (Elsevier), IEEE Access, Security & Communication Networks,
[234] P. M. Rao and B. Deebak, “A comprehensive survey on authentication IEEE Consumer Electronics Magazine. His current research interests include
and secure key management in internet of things: Challenges, counter- Cybersecurity, biometrics, multimedia security, and digital authentication. He
measures, and future directions,” Ad Hoc Networks, p. 103159, 2023. is a Fellow of the IET (UK), Fellow of the BCS (UK), Fellow of the FTRA
[235] D. He and S. Zeadally, “An analysis of rfid authentication schemes (Korea), senior member of the IEEE (USA), a member of the IEEE Technical
for internet of things in healthcare environment using elliptic curve Committee on Security & Privacy, and a member of the IEEE Cybersecurity
cryptography,” IEEE internet of things journal, vol. 2, no. 1, pp. 72– community
83, 2014.
[236] J. Liu, H. Cao, Q. Li, F. Cai, X. Du, and M. Guizani, “A large-
scale concurrent data anonymous batch verification scheme for mobile
healthcare crowd sensing,” IEEE Internet of things Journal, vol. 6,
no. 2, pp. 1321–1330, 2018.
[237] R. Kumar, P. Kumar, R. Tripathi, G. P. Gupta, A. N. Islam, and
M. Shorfuzzaman, “Permissioned blockchain and deep learning for
secure and efficient data sharing in industrial healthcare systems,” IEEE
Transactions on Industrial Informatics, vol. 18, no. 11, pp. 8065–8073,
2022.
[238] S. Singh, S. Rathore, O. Alfarraj, A. Tolba, and B. Yoon, “A framework
for privacy-preservation of iot healthcare data using federated learning
and blockchain technology,” Future Generation Computer Systems, vol.
129, pp. 380–388, 2022.
[239] S. Sengan, O. I. Khalaf, D. K. Sharma, A. A. Hamad et al., “Secured
and privacy-based ids for healthcare systems on e-medical data using
machine learning approach,” International Journal of Reliable and
Quality E-Healthcare (IJRQEH), vol. 11, no. 3, pp. 1–11, 2022.
[240] J. Winter, “The evolutionary and disruptive potential of industrie 4.0,”
Hungarian Geographical Bulletin, vol. 69, no. 2, pp. 83–97, 2020.
[241] B. Gajdzik, “Changes in the steel industry in poland in the period from
1990 to 2020. innovation and digitization on the way to steel mills 4.0.”
[242] A. A. Wagire, R. Joshi, A. P. S. Rathore, and R. Jain, “Development
of maturity model for assessing the implementation of industry 4.0:
learning from theory and practice,” Production Planning & Control,
vol. 32, no. 8, pp. 603–622, 2021.
26
Neeraj Kumar (SMIEEE) (2019, 2020, 2021 Mohsen Guizani (Fellow, IEEE) received the
highly-cited researcher from WoS) is working as B.S. (with Distinction) and M.S. degrees in elec-
a Full Professor in the Department of Computer trical engineering, and the M.S. and Ph.D. degrees
Science and Engineering, Thapar Institute of Engi- in computer engineering from Syracuse University,
neering and Technology (Deemed to be University), Syracuse, NY, USA, in 1984, 1986, 1987, and 1990,
Patiala (Pb.), India. He has published more than respectively. He is currently a Professor with the
600 technical research papers (in top-cited journals Machine Learning Department, Mohamed Bin Za-
and conferences which are cited more than 35271 yed University of Artificial Intelligence, Abu Dhabi,
times from well-known researchers across the globe UAE. He has authored nine books and more than 500
with a current h-index of 114). He has guided many publications in refereed journals and conferences.
research scholars leading to Ph.D. and M.E./M.Tech. His research interests include wireless communica-
His research is supported by funding from various competitive agencies tions and mobile computing, Internet of Things (IoT), and application of
across the globe. His broad research areas are Green computing and Network machine learning in communication. He is also a Senior Member of ACM
management, IoT, Big Data Analytics, Deep learning and cyber-security.
He has also edited/authored 10 books with International/National Publishers
like IET, Springer, Elsevier, CRC. He is serving as an editor of the ACM Zhanpeng Jin (S’07-M’10-SM’15) is currently a
Computing Survey, IEEE Transactions on Sustainable Computing, IEEE Xinshi Endowed Professor in the School of Future
TNSM, Elsevier Computer Communication, Wiley International Journal of Technology at the South China University of Tech-
Communication Systems. He has won the best papers award from IEEE nology, China, and also an Associate Professor in the
Systems Journal in 2018, in 2020, and IEEE ICC 2018, Kansas City in 2018. Department of Computer Science and Engineering at
He has also won best paper award from Elsevier JNCA in 2021 and IEEE the University at Buffalo, USA. He was an Associate
Comsoc IWCMC 2021. He has won the Outstanding Leadership Award from Professor in Electrical and Computer Engineering,
IEEE Trsutcom in 2021. and Biomedical Engineering, at Binghamton Univer-
sity, as well as a Postdoctoral Research Associate
at the University of Illinois at Urbana-Champaign
(UIUC). He received his Ph.D. degree in Electrical
Muhammad Attique (Member, IEEE) received the Engineering from the University of Pittsburgh. His research interests include
bachelor’s degree in information and communication ubiquitous computing, human-computer interaction, and AI-powered smart
systems engineering from the National University of health and smart home. He is a Senior Member of ACM and IEEE, and serves
Science and Technology, Pakistan, in 2008, and the as an Associate Editor for the following journals: ACM Computing Surveys,
Ph.D. degree in computer engineering from Ajou Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous
University, South Korea, in 2017. He is currently Technologies (IMWUT), and Elsevier Computers in Biology and Medicine.
working as an Assistant Professor with the Depart- He has published over 100 papers in international journals and conferences.
ment of Software, Sejong University, South Korea. He received the IEEE Region 1 Technological Innovation Award. His pioneer
His research interests include spatial computing, work in brain biometrics was selected and named as one of the “Future
geosocial queries, location-based applications, and Technology: 22 Ideas About to Change Our World” by BBC Science Focus.
big data analysis.
Ahmed Farouk (Member, IEEE) is currently as-

sistant professor, before that he was a Postdoctoral
Research Fellow at Wilfrid Laurier University and
Ryerson University, Canada. He received his M.Sc.
and Ph.D. degrees from Mansoura University, Egypt.
He is one of the Top 20 technical co-founders of
the Quantum Machine Learning Program by Cre-
ative Destruction Lab at the University of Toronto.
Furthermore, he is selected as Top 25 of Innovate
TO 150 Canada to showcase the best of Toronto’s
next generation of change-makers, innovators, and
entrepreneurs. He is exceptionally well known for his seminal contributions
to theories of Quantum Information, Communication, and Cryptography. He
published 62 papers in reputed and high impact journals like Nature Scientific
Reports and Physical Review A. The exceptional quality of his research is
recognized nationally and internationally. He selected by the scientific review
panel of the Council for the Lindau Nobel Laureate Meetings to participate in
the 70th Lindau Nobel Laureate Meeting. His volunteering work is apparent
since he appointed as chair of the IEEE computer chapter for the Waterloo-
Kitchener area and editorial board for many reputed journals like Nature
Scientific Reports, IET Quantum Communication, and IEEE Access. Also, he
selected for IEEE and IET Young Professional Ambassador and as a moderator
for the new IEEE TechRxiv. Recently, he appointed as an associate editor for
the IEEE Canadian Review (ICR).

Healthcare Internet of Things Security Threats Challenges and Future Research Directions

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Healthcare Internet of Things Security Threats Challenges and Future Research Directions

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This article has been accepted for publication in IEEE Internet of Things Journal.

Healthcare Internet of Things: Security Threats,

Abstract—Internet of Things (IoT) applications are switching I. I NTRODUCTION

Contributions Paper Related Review Articles Conclusion

Secure key Secure multi-factor User’s Interopera

Secure Handover of Secure data Storage

Fig. 1: Paper organization flowchart

Start searching the below

Narrow our search to

Finally evaluated HC-IoT security

Papers they have the

IEEE Xplore, Google Scholar ACM

Full text regarding After removing

TABLE II: Security requirements of HC-IoT applications (Question 1)

Meneghello et al. [10] Yes Partially Yes Yes No

Access Control and Resilience Security Requirements Relative Percentage

Software & Configuration

Compatibility, Traceability &

Maintainability and Monitoring

Secure data Transmission 6 %

Heterogeneous HC-IoT Monitoring 7 %

Security Policy Enforcement 8 %

Threat Response Monitoring 11 %

Flow Control Maintainability 14 %

Fig. 5: Maintainability and Monitoring security requirement statistical analysis

TABLE V: Authentication scheme used for HC-IoT Networks Comparative Analysis

the literature. As a result of this, when we look at TABLE VII,

wide range of works to be performed in this field in the future.

IV. E XISTING T HREATS C OUNTERMEASURE S CHEMES

B. Physical Layer Security Threats D. Application Layer Security Threats

Security requirement Description of category overall relative percentage (%)

Secure information exchange Information security Very high (10.2% )

TABLE VIII: Security requirements of HC-IoT applications (Question 1)

To ensure the research of the aforestated domain, we

to present a way for new thoughts on the current problem and

Future research initiatives D. Maintainability and Monitoring Security Challenges

TABLE IX: Future Research Opportunities Comparative Analysis

Ahmed Farouk (Member, IEEE) is currently as-

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