Exploring Authentication Protocols for Secure and Efficient Internet of Medical Things Systems

The Internet of Medical Things (IoMT) comprises the application of traditional Internet of Things (IoT) technologies in the healthcare domain. IoMT ensures seamless data-sharing among hospitals, patients, and healthcare service providers, thereby transforming the medical environment. The adoption of IoMT technology has made it possible to provide various medical services such as chronic disease care, emergency response, and preventive treatment. However, the sensitivity of medical data and the resource limitations of IoMT devices present persistent challenges in designing authentication protocols. Our study reviews the overall architecture of the IoMT and recent studies on IoMT protocols in terms of security requirements and computational costs. In addition, this study evaluates security using formal verification tools with Scyther and SVO Logic. The security requirements include authentication, mutual authentication, confidentiality, integrity, untraceability, privacy preservation, anonymity, multi-factor authentication, session key security, forward and backward secrecy, and lightweight operation. The analysis shows that protocols satisfying a multiple security requirements tend to have higher computational costs, whereas protocols with lower computational costs often provide weaker security. This demonstrates the trade-off relationship between robust security and lightweight operation. These indicators assist in selecting protocols by balancing the allocated resources and required security for each scenario. Based on the comparative analysis and a security evaluation of the IoMT, this paper provides security guidelines for future research. Moreover, it summarizes the minimum security requirements and offers insights that practitioners can utilize in real-world settings.