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Scientific Reports

A resilient and efficient authentication and key agreement protocol for medical IoT: the PSU-MAKA framework

Difei Fu

Published Aug 5, 2026• 0 citations
Publisher

Abstract

The Internet of Medical Things (IoMT) is gaining attention for its ability to enhance patient monitoring and decrease medical costs, driving advancements in personalized medicine. However, IoMT suffers from the security issue of data breaches resulting from unauthorized access, this issue hinders IoMT’s broader adoption. The introducing of mutual authentication and key agreement (MAKA) to robustly verify the identities of communicating entities, thus ensuring that access to information is limited to permitted users and blocking unauthorized access. But, to our knowledge, current MAKA schemes expose limitations such as performance complexity, potential security vulnerabilities. This study presents a provably secure user MAKA protocol (PSU-MAKA) for IoMT. The proposed PSU-MAKA allows users to complete the registration process without the need for a secure channel, while also supporting key agreement and password update. Then, the security analysis in this study illustrates the PSU-MAKA’s robustness against the potential security vulnerabilities. Lastly, this study gives the evidence that the PSU-MAKA offers superior performance in relation to other competing solutions regarding communication, computational, and storage overhead.

DOI
10.1038/s41598-026-65404-9

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The Internet of Medical Things (IoMT) is gaining attention for its ability to enhance patient monitoring and decrease medical costs, driving advancements in personalized medicine. However, IoMT suffers from the security issue of data breaches resulting from unauthorized access, this issue hinders IoMT’s broader adoption. The introducing of mutual authentication and key agreement (MAKA) to robustly verify the identities of communicating entities, thus ensuring that access to information is limited to permitted users and blocking unauthorized access. But, to our knowledge, current MAKA schemes expose limitations such as performance complexity, potential security vulnerabilities. This study presents a provably secure user MAKA protocol (PSU-MAKA) for IoMT. The proposed PSU-MAKA allows users to complete the registration process without the need for a secure channel, while also supporting key agreement and password update. Then, the security analysis in this study illustrates the PSU-MAKA’s robustness against the potential security vulnerabilities. Lastly, this study gives the evidence that the PSU-MAKA offers superior performance in relation to other competing solutions regarding communication, computational, and storage overhead.
The Internet of Medical Things (IoMT) is a network of medical devices, hardware infrastructure, and software that accumulates real-time data through remote monitoring and minimizes doctor-patient interaction, enhancing the quality of remedies. However, the facile availability and accessibility of data over the web have given rise to serious information security and credibility issues in the IoMT. Recently, Chen et al. [1] proposed a provably secure authenticated key agreement protocol for remote patient monitoring in IoMT. However, after revisiting their scheme, we found security flaws such as user impersonation, ephemeral secret leakage attacks, denial-of-service attacks, and session key disclosure attacks. Therefore, this paper presents cryptanalysis as well as an improvement of Chen et al. 's scheme that strives to furnish protocols with robust security in opposition to the mentioned attacks. The security and effectiveness are displayed through informal analysis and evaluation with other existing state-of-the-art metrics like computational and commu-nication cost. At last, the findings project the superiority of the proposed improved scheme.
The rapid integration of the Internet of Medical Things (IoMT) into healthcare systems raises urgent demands for secure communication mechanisms capable of protecting sensitive patient data. Quantum key agreement (QKA), a collaborative approach to key generation based on quantum principles, provides an attractive alternative to traditional quantum key distribution (QKD), as it eliminates dependence on a trusted authority and ensures equal participation from all users. QKA demonstrates particular suitability for IoMT’s decentralized medical networks by eliminating trusted authority dependence while ensuring equitable participation among all participants. This addresses fundamental challenges where centralized trust models introduce vulnerabilities and asymmetric access patterns that compromise egalitarian principles essential for medical data sharing. However, practical QKA applications in IoMT remain limited, particularly for schemes that avoid complex entanglement operations and authenticated classical channels. Among the few QKA protocols employing Grover’s search algorithm (GSA), existing proposals potentially suffer from limitations in fairness and security. In this paper, the author proposes an improved GSA-based QKA protocol that ensures fairness, security, and correctness without requiring an authenticated classical communication channel. The proposed scheme guarantees that each participant’s input equally contributes to the final key, preventing manipulation by any user subgroup. The scheme combines Grover’s algorithm with the decoy photon technique to ensure secure quantum transmission. Security analysis confirms resistance to external attacks, including intercept-resend, entanglement probes, and device-level exploits, as well as insider threats such as parameter manipulation. Fairness is achieved through a symmetric protocol design rooted in quantum mechanical principles. Efficiency evaluation shows a theoretical efficiency of approximately 25%, while eliminating the need for quantum memory. These results position the proposed protocol as a practical and scalable solution for future secure quantum communication systems, particularly within distributed IoMT environments.
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.
As the healthcare sector transitions to the Internet of Medical Things (IoMT), it promises significant improvements in productivity by streamlining processes, reducing administrative burdens, and automating routine tasks. However, the current authentication methods are vulnerable due to reliance on simple passwords and a lack of additional protective layers, posing a heightened risk of data breaches. Given the significant value of medical data, security measures for medical devices remain inadequate, especially in safeguarding user and device identities against future quantum computing threats. This paper proposes an enhanced authentication protocol aimed at ensuring the confidentiality and integrity of medical data. The protocol validates user and device identities while incorporating post-quantum cryptography to address upcoming challenges posed by quantum technology.
With the significant development of the Internet, Internet of Things (IoT) has become an emerging technology in many industries. To support security and privacy in the Industrial IoT environment, a user may interact with another user on the Internet to share confidential information, which requires an authenticated communication channel. To meet this demand, in this article the authors developed an identity-based two-party authenticated key agreement (ID-2PAKA) protocol that allows two users to communicate securely and share sensitive data across IoT-enabled regions. Similar protocols found in the literature either proven to be insecure or carry the burden of high communication and computational costs. The proposed ID-2PAKA protocol is analyzed in the random oracle model to achieve provable security based on the hardness assumptions of computational Diffie-Hellman and bilinear Diffie-Hellman problems. The performance analysis of the proposed ID-2PAKA protocol is performed using the pairing-based cryptography library. The comparative results from the perspective of the computation and communication costs against the competing protocols showed that the proposed ID-2PAKA protocol is secure and efficient.
Secure communication and authentication in the Internet of Medical Things (IoMT) are critical for patient safety and healthcare data protection, yet existing protocols face significant vulnerabilities that remain undetected by conventional verification approaches. This paper presents the computational security verification of an IoMT authentication protocol incorporating NTRU lattice-based post-quantum cryptography using CryptoVerif, a formal verification tool that provides concrete probability bounds under standard cryptographic assumptions. Through systematic analysis of a multi-entity healthcare protocol, this study identifies two critical security flaws overlooked by previous symbolic verification methods: device registration authentication failure enabling man-in-the-middle device substitution attacks, and forward secrecy violation through static key encryption that exposes historical medical data upon key compromise. To address these vulnerabilities, we provide an enhanced protocol incorporating Strong Unforgeability under Chosen Message Attacks (SUF-CMA) MAC-based device authentication that cryptographically binds device identity to patient identity, and HMAC-based key derivation function (HKDF)-derived ephemeral session keys that achieve forward secrecy through fresh key derivation for each communication session. Our CryptoVerif implementation successfully proves nine security properties including mutual authentication, data confidentiality, device binding, and forward secrecy, with aggregate security bound for 128-bit quantum-resistant security. Unlike symbolic verification tools that assume perfect cryptography, our computational analysis provides concrete security guarantees essential for safety-critical healthcare systems.