The Internet of Medical Things (IoMT) has become a core component of modern healthcare infrastructures, enabling continuous patient monitoring, remote diagnostics, and data-driven clinical decision-making. Despite these advances, authentication in IoMT environments remains a critical security challenge, intensified by strict resource constraints of medical devices and the emerging threat posed by quantum computing to classical cryptographic techniques. This systematic review investigates authentication mechanisms in IoMT from both post-quantum and system-level perspectives. A structured literature review was conducted using a PRISMA-informed methodology across major scientific databases, including IEEE Xplore, ACM Digital Library, SpringerLink, ScienceDirect, and MDPI. From an initial set of 95 records, 63 studies were selected for qualitative synthesis following screening and eligibility assessment. To organise existing research, this study introduces a multi-dimensional classification framework that categorises authentication solutions according to cryptographic paradigm (classical, hybrid, and post-quantum), deployment architecture, system objectives, and clinical operational constraints. The comparative synthesis demonstrates important trade-offs between security strength, latency, computational overhead, and energy consumption that are frequently underexplored in the existing literature. Furthermore, the analysis identifies key research gaps related to scalability in heterogeneous medical environments, trust establishment across administrative and clinical domains, usability under strict timing constraints, and resilience against quantum-capable adversaries. Based on these findings, future research directions are outlined toward adaptive, lightweight, and context-aware post-quantum authentication frameworks designed for real-world IoMT deployments. Limitations of this review include restriction to English-language publications and selected databases. This study received no external funding, and the review protocol was not formally registered.
The Internet of Medical Things (IoMT) has become a core component of modern healthcare infrastructures, enabling continuous patient monitoring, remote diagnostics, and data-driven clinical decision-making. Despite these advances, authentication in IoMT environments remains a critical security challenge, intensified by strict resource constraints of medical devices and the emerging threat posed by quantum computing to classical cryptographic techniques. This systematic review investigates authentication mechanisms in IoMT from both post-quantum and system-level perspectives. A structured literature review was conducted using a PRISMA-informed methodology across major scientific databases, including IEEE Xplore, ACM Digital Library, SpringerLink, ScienceDirect, and MDPI. From an initial set of 95 records, 63 studies were selected for qualitative synthesis following screening and eligibility assessment. To organise existing research, this study introduces a multi-dimensional classification framework that categorises authentication solutions according to cryptographic paradigm (classical, hybrid, and post-quantum), deployment architecture, system objectives, and clinical operational constraints. The comparative synthesis demonstrates important trade-offs between security strength, latency, computational overhead, and energy consumption that are frequently underexplored in the existing literature. Furthermore, the analysis identifies key research gaps related to scalability in heterogeneous medical environments, trust establishment across administrative and clinical domains, usability under strict timing constraints, and resilience against quantum-capable adversaries. Based on these findings, future research directions are outlined toward adaptive, lightweight, and context-aware post-quantum authentication frameworks designed for real-world IoMT deployments. Limitations of this review include restriction to English-language publications and selected databases. This study received no external funding, and the review protocol was not formally registered.
The rapid deployment of Internet of Things (IoT) devices across critical infrastructure’s sectors such as healthcare, transportation, and smart cities brings unprecedented security challenges; particularly as quantum computing threatens the classical cryptography. This systematic review analyzes IoT security in relation to post-quantum cryptography (PQC), highlighting vulnerabilities, evolving threat, and cryptographic countermeasures. Using the PRISMA 2020 protocol, our work employed a rigorous and reproducible search strategy, where the initial Boolean query, ((“IoT” OR “Internet of Things”) AND (“Cryptography” OR “Encryption Scheme”) AND “Quantum”), was developed and effectively customized for nine reputable databases to maximize the coverage. From an initial pool of 5,151 publications dated between 2020 and February 12, 2025, a content-based screening was conducted at the title, abstract, and full-text levels. This meticulous filtering resulted in a final corpus of 161 studies deemed relevant for in-depth analysis and synthesis. Then, we categorize and analyze PQC algorithms by vulnerabilities, suitability for resource-constrained IoT environments, performance evaluation, scalability, and quantum resilience. We also identify key limitations in implementations of current cryptographic schemes, including issues in key management and authentication; and outline major challenges such as resource constraints of IoT devices, environmental noise, quantum reversible computing, security vulnerabilities, quantum hardware constraints, and complexities in integration. To counter these threats, we propose a framework of PQC countermeasures and illustrated by a hypothetical case study of PQC adoption in a real-world IoT system. Finally, we propose future research directions in lightweight PQC, hybrid frameworks, improved key management and distribution, addressing quantum distance matters, countering quantum threats, and standardization for IoT environments.
The rapid digitalisation of healthcare has accelerated the adoption of telemedicine, Electronic Health Records (EHRs), and the Internet of Medical Things (IoMT), transforming healthcare delivery into a highly interconnected and patient-centric ecosystem. In response to growing concerns about data security, privacy, and interoperability, blockchain technology has emerged as a promising solution for its decentralization, immutability, auditability, and secure access control. However, many existing blockchain infrastructures rely on classical cryptographic primitives, including RSA- or elliptic-curve-based public-key mechanisms and cryptographic hash functions such as SHA-256, whose relevant security properties may be affected by sufficiently powerful quantum attacks. This review investigates the convergence of blockchain and quantum technologies to address emerging security threats in e-health systems. A structured literature review was conducted in accordance with the PRISMA 2020 guidelines using the IEEE Xplore, PubMed, ACM Digital Library, Google Scholar, and Crossref databases, covering studies published between January 2018 and June 2025. Following a systematic screening and eligibility-verification process, 57 relevant studies were selected and analyzed. The review evaluates quantum-resilient security mechanisms, including Quantum Key Distribution (QKD), Quantum Random Number Generation (QRNG), and NIST-standardized Post-Quantum Cryptography (PQC) algorithms specified in FIPS 203, FIPS 204, and FIPS 205. Based on the identified research gaps in the state of the art, this study also proposes a novel four-layer Quantum-Blockchain Security Architecture (QBSA) designed for secure healthcare environments. The analysis further reveals significant challenges associated with lightweight PQC deployment for IoMT devices, interoperability standardization, quantum hardware limitations, and regulatory compliance in cross-institutional healthcare systems. The findings highlight the necessity of integrating quantum-resilient cryptographic frameworks with blockchain infrastructures to support the development of secure, scalable, and patient-centric next-generation e-health ecosystems.
The increasing digitalization of the healthcare system, driven by electronic health records, medical IoT devices, and AI-aided diagnostics, has significantly expanded the attack surface for cyber threats. Although current cryptographic protocols provide sufficient security against classical adversaries, new developments in quantum computing threaten the confidentiality, integrity, and availability of medical information as never before. Shor’s algorithm could break widely used asymmetric encryption systems, and Grover’s algorithm weakens symmetric ones, which could render modern healthcare security systems obsolete. This review provides an in-depth and organized analysis of the evolving quantum threat environment in healthcare ecosystems and of the need to move toward quantum-resilient security architectures. It synthesizes the existing literature on post-quantum cryptography (PQC) and identifies lattice-based, hash-based, multivariate, and code-based algorithms as potentially viable long-term replacements. Moreover, it examines the cybersecurity issues that quantum-enabled attacks pose to medical IoT systems, clinical decision-support systems, wearable sensors, telemedicine systems, and cloud-based health information exchanges. The review also covers hybrid quantum-classical defenses, quantum key distribution (QKD), quantum random number generation (QRNG), and blockchain-based trust systems that aim to make systems resilient to advanced persistent quantum attacks. This paper identifies key gaps and outlines future research directions for developing quantum-secure medical systems. The results highlight the importance of early adoption of PQC standards and a layered cyber defense approach to protect patient privacy, ensure regulatory compliance, and retain trust in next-generation digital medical data communication.
The emergence and growth of the Internet of Medical Things (IoMT) have transformed the way healthcare services are delivered, but this growth comes with its own security challenges, especially with the emergence of quantum computing. This paper presents a lightweight, privacy-preserving authentication scheme for edge-based IoMT environments, integrating CRYSTALS-Kyber Key Encapsulation Mechanism (KEM) to securely establish session keys between participating entities and resilience against quantum attacks, while CRYSTALS-Dilithium is utilized as the digital signature scheme to ensure message integrity, authentication, and non-repudiation. These NIST-standardized post-quantum primitives collectively strengthen the system's resistance against quantum adversaries and enhance overall cryptographic robustness. The proposed system comprises two phases: Registration and Authentication. During registration, patients, wearable devices that utilize Physically Unclonable Functions (PUFs), and medical specialists register with a Trusted Authority via edge nodes. The authentication phase encompasses mutual authentication among patients, devices, medical specialists, edge nodes, and cloud servers, ensuring that only authorized entities access sensitive health information. In addition, the proposed scheme employs the formal security properties, such as authenticity and secrecy, are verified using the AVISPA tool under the Dolev-Yao model, with results confirming that all defined goals are achieved and no attacks are found. Performance evaluations indicate that the scheme is computationally efficient and suitable for resource-constrained IoMT devices. Furthermore, BAN logic is employed to formally verify the correctness of the authentication protocol, demonstrating that mutual authentication is securely established among the participating entities under well-defined trust assumptions. By integrating post-quantum cryptographic techniques, this authentication framework addresses emerging security challenges posed by quantum computing, aligning with the objectives of enhancing edge-based consumer electronics devices and Internet of Things (IoT) ecosystems with post-quantum cryptosystems.
The traditional cryptographic methods used to protect healthcare data, especially for the long-term storage of medical imaging records, are becoming increasingly threatened by the quick development of quantum computing. The purpose of this study is to assess the challenges, efficacy, and preparedness of integrating Post-Quantum Cryptography (PQC) into healthcare information systems. Twenty peer-reviewed studies published between 2020 and 2025 were analysed following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) protocol. The review was conducted using a systematic research design that included qualitative thematic synthesis, predetermined eligibility criteria, and database searching. According to the results, lattice-based PQC schemes, specifically, CRYSTALS-Kyber for encryption and CRYSTALS-Dilithium for authentication, show great promise because of their effectiveness, resilience, and suitability for decentralized architectures like blockchain and Internet-of-Medical-Things environments. Nonetheless, the review points out a notable deficiency of empirical assessment in actual healthcare settings, particularly with regard to cloud-based platforms and Picture Archiving and Communication Systems utilized in medical imaging processes. Scalability limitations, intricate key-management specifications, system interoperability restrictions, and the requirement for conformity with regulatory and compliance frameworks are some of the major issues noted. The results indicate that lattice-based PQC schemes have great promise, deployment readiness remains largely at the conceptual and experimental stage, particularly for cloud-based PACS environments. Real-world implementation validation in a healthcare setting has not been achieved.
The Internet of Medical Things (IoMT) is a compelling networking paradigm integrating wireless communications sensors, connected devices, and embedded computing technologies. The IoMT involves the collection of real-time health data using sophisticated medical sensors. In recent years, the IoMT has become increasingly significant within the broader context of the Internet of Things (IoT). It provides accessibility for health monitoring and poses security obstacles to safeguarding the confidentiality and privacy of patient data. Therefore, this article presents a blockchain-integrated quantum authentication scheme in sensor-assisted IoMT networks. The proposed concept utilizes blockchain technology to achieve efficient patient authentication without the need for third-party entities. In addition, a secure quantum authentication scheme is designed not to require patients to authenticate themselves when communicating with multiple doctors simultaneously. This protocol explicitly addresses how clinicians can misuse their professional roles toward patients in IoMT networks. An evaluation analysis assesses the proposed technique’s efficacy compared to existing authentication schemes. The performance analyses demonstrate that the proposed protocol is resilient against various security attacks. Also, the practical usability of the quantum authentication scheme proved its importance as a significant improvement in communication security for IoMT networks.