SAF-IoMT: Secure authentication framework for IoMT-enabled smart healthcare system

Abstract

The Internet of Medical Things (IoMT) represents an advanced evolution of the Internet of Things (IoT), enabling secure and intelligent interactions among connected medical devices and significantly improving the efficiency and reliability of modern healthcare systems. In the IoMT environment, maintaining data similarity, integrity, and secure transmission is critical, particularly during emergencies such as the COVID-19 pandemic, when real-time, trustworthy medical data exchange becomes essential. Authentication protocols are indispensable for verifying the identities of communicating entities, preserving data integrity, preventing unauthorized access, and securing communication channels against malicious adversaries. However, many existing authentication schemes remain impractical for resource-constrained IoT medical devices due to high computational requirements and exposure to various security vulnerabilities. To address these challenges, we present SAF-IoMT, a mutual authentication protocol specifically designed for device-to-server communication within IoMT-enabled smart healthcare systems. SAF-IoMT integrates a PUF with the lightweight cryptographic primitive ASCON, thereby reducing operational overhead while maintaining strong security assurances. This design makes SAF-IoMT highly suitable for medical devices with limited processing capabilities and battery constraints. By enhancing security across the IoMT network, SAF-IoMT ensures reliable operation of medical devices, especially under critical healthcare conditions. The security of SAF-IoMT has been validated through both formal and informal security analyses. At the same time, performance evaluation demonstrates considerable reductions in computational cost (19.29% to 75.20%) and communication cost (11% to 66%) compared with existing related protocols.