Keshta Ismail
Department of Computer Science and Information Systems, College of Applied Sciences, AlMaarefa University, Riyadh, Saudi Arabia.
PLoS One. 2025 Jun 3;20(6):e0322313. doi: 10.1371/journal.pone.0322313. eCollection 2025.
Secure data transmission is critical to cloud-based electronic healthcare (e-healthcare) systems. Upon delving into the literature, it becomes clear that several security mechanisms have been developed to ensure the security of exchanged information across patients, physicians, and the cloud server, but they do not resist vulnerabilities such as man-in-the-middle, side-channel, and session key hijacking attacks. These vulnerabilities can seriously compromise the integrity of exchanged medical records. In light of this, the article proposes a cloud-assisted key agreement protocol for the e-healthcare system to enable secure authentication for patient monitoring, enhancing mutual authentication of the participating entities and creating protected session keys for secure open-channel communication. The proposed methodology employs robust and lightweight procedures, including SHA-256 and Elliptic Curve Cryptography (ECC), while considering the challenges of implementing strong security protocols in healthcare systems, such as the need for high performance and low energy consumption. The proof of correctness and robustness of the proposed protocol has been analyzed through the Real-Or-Random (RoR) model, ProVerif verification toolkit, and pragmatic illustration, while the efficiency and efficacy were checked by measuring computation, communication, storage costs, and energy consumption. The result obtained from the security analysis demonstrated that the proposed protocol resisting man-in-the-middle, replay, DoS, traceability/tracking, desynchronization, impersonation, and side channel attacks offers key secrecy, confidentiality, integrity, and authorization. In contrast, the result depicted from the performance analysis section shows that the proposed protocol is 46.99% better in communication, 96.46% in computation, and 53.69% in energy consumption, which is inaugurating its superiority over its competitors. Hence, it is recommended for practical implementation in the real-world cloud-based e-healthcare scenario.
安全的数据传输对于基于云的电子医疗保健（电子医疗）系统至关重要。深入研究文献后可以清楚地发现，已经开发了几种安全机制来确保患者、医生和云服务器之间交换信息的安全性，但它们无法抵御中间人攻击、侧信道攻击和会话密钥劫持攻击等漏洞。这些漏洞可能会严重损害交换的医疗记录的完整性。鉴于此，本文提出了一种用于电子医疗系统的云辅助密钥协商协议，以实现患者监测的安全认证，增强参与实体的相互认证，并创建用于安全开放信道通信的受保护会话密钥。所提出的方法采用了强大且轻量级的程序，包括SHA-256和椭圆曲线密码学（ECC），同时考虑了在医疗系统中实施强大安全协议所面临的挑战，例如对高性能和低能耗的需求。通过真或随机（RoR）模型、ProVerif验证工具包和实际示例分析了所提出协议的正确性和鲁棒性证明，同时通过测量计算、通信、存储成本和能耗来检查效率和效能。从安全分析中获得的结果表明，所提出的协议能够抵御中间人攻击、重放攻击、拒绝服务攻击、可追溯性/跟踪攻击、去同步攻击、伪装攻击和侧信道攻击，提供密钥保密性、机密性、完整性和授权。相比之下，性能分析部分所描绘的结果表明，所提出的协议在通信方面比其他协议好46.99%，在计算方面好96.46%，在能耗方面好53.69%，这表明它比竞争对手具有优势。因此，建议在实际的基于云的电子医疗场景中进行实际实施。
