Can Formal Security Verification Really Be Optional? Scrutinizing the Security of IMD Authentication Protocols

The need for continuous monitoring of physiological information of critical organs of the human body, combined with the ever-growing field of electronics and sensor technologies and the vast opportunities brought by 5G connectivity, have made implantable medical devices (IMDs) the most necessitated devices in the health arena. IMDs are very sensitive since they are implanted in the human body, and the patients depend on them for the proper functioning of their vital organs. Simultaneously, they are intrinsically vulnerable to several attacks mainly due to their resource limitations and the wireless channel utilized for data transmission. Hence, failing to secure them would put the patient's life in jeopardy and damage the reputations of the manufacturers. To date, various researchers have proposed different countermeasures to keep the confidentiality, integrity, and availability of IMD systems with privacy and safety specifications. Despite the appreciated efforts made by the research community, there are issues with these proposed solutions. Principally, there are at least three critical problems. (1) Inadequate essential capabilities (such as emergency authentication, key update mechanism, anonymity, and adaptability); (2) heavy computational and communication overheads; and (3) lack of rigorous formal security verification. Motivated by this, we have thoroughly analyzed the current IMD authentication protocols by utilizing two formal approaches: the Burrows-Abadi-Needham logic (BAN logic) and the Automated Validation of Internet Security Protocols and Applications (AVISPA). In addition, we compared these schemes against their security strengths, computational overheads, latency, and other vital features, such as emergency authentications, key update mechanisms, and adaptabilities.