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Threat Modeling Towards Resilience in Smart ICUs
Abstract
Healthcare digitization has significantly enhanced patient care and alleviated the workload of hospital staff. This trend towards automation has also optimized the intensive care units (ICUs) of hospitals, leading to the emergence of smart ICUs equipped with modern wireless communication networks like 5G. However, this increased digitization presents new attack vectors and opportunities, especially regarding cybersecurity attacks. These attacks could compromise the resilience of smart ICU networks. Given the critical role of ICUs in healthcare, it is imperative to analyze and categorize digital threats in terms of the risks they pose to patients. This paper explores cybersecurity threats for smart ICU networks and offers a risk assessment of the potential worst-case impacts these threats could have on the network.
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There is a growing demand for intensive care units, but there is a relative shortage of medical staff. Intensive care work is heavy and stressful. Optimizing the working conditions and processes of the intensive care unit is of great significance for improving the work efficiency and the level of diagnosis and treatment in the intensive care unit. The intelligent intensive care unit is a new ward management model gradually developed on the basis of modern science and technology such as communication technology, internet of things, artificial intelligence, robots, and big data. Under this model, the potential risks caused by human factors are greatly reduced, and the monitoring and treatment of patients has been significantly improved. This paper reviews the progress in related fields.
Provisioning of health services such as care, monitoring, and remote surgery is being improved thanks to fifth-generation cellular technology (5G). As 5G expands globally, more smart healthcare applications have been developed due to its extensive eMBB (Enhanced Mobile Broadband) and URLLC (Ultra-Reliable Low Latency Communications) features that can be used to generate healthcare systems that allow minimizing the face-to-face assistance of patients at hospital centers. This powerful network provides high transmission speeds, ultra-low latency, and a network capacity greater than that of 4G. Fifth-generation cellular technology is expected to be a means to provide excellent quality of medical care, through its technological provision to the use of IoMT (Internet of Medical Things) devices. Due to the numerous contributions in research on this topic, it is necessary to develop a review that provides an orderly perspective on research trends and niches for researchers to use as a starting point for their work. In this context, this article presents a systematic review based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), with article selection based on inclusion and exclusion criteria that avoid bias. This research was based on research questions that were answered from the included works. These questions focus on technical characteristics, health benefits, and security protocols necessary for the development of smart healthcare applications. We have identified that a high percentage of existing works in the literature are proposals (56.81%, n = 25) and theoretical studies (22.73%, n = 10); few implementations (15.91%, n = 7) and prototypes (4.55%, n = 2) exist, due to the limited global deployment of 5G. However, the panorama looks promising based on proposals and future work that these technological systems allow, all based on improving healthcare for people.
By virtue of being in a developing country with ongoing expanding of the healthcare system, establishing or at least renovating a Pediatric critical care unit (PICU) has become a necessity. As intensivists and healthcare providers, we excel at our job as clinicians; however, we perform less than perfect when it comes to participating in establishing new PICUs and deliberately building and designing an EBM and patient-centered PICU with a complete understanding of the technical and non-clinical processes during commissioning or operational phases like construction, physical layout (blueprint), Biomedical engineering aspects, equipment, supply, and work-environment enhancement. If all healthcare providers -and especially intensivists- avoid being involved actively in PICUs designing process at their institution, they will miss an opportunity to gain a new perspective as well as they might contribute to a fragmented process of ICU design and a suboptimal result that might impact the PICU environment, patient journey and eventually the quality of care in that ICU.
The PICU designing processes should be handled via a multi-professional team approach in an integrated -not parallel- manner that includes clinical and non-clinical personnel. Therefore, the processes will be more integrated, and they will finish the project efficiently, effectively, safely, and patient-centered way.
This paper is an expert opinion and literature review that describes a conceptual framework to guide simple and practical mental processes in establishing and designing processes for new PICUs in developing countries. We called this preparedness tool: the 4S framework (system, space, staff, and stuff). It is a well-known preparedness tool that is commonly used in planning new projects by project leaders. Therefore, we utilized it in establishing a new PICU intended to meet the national and international accreditation standards and requirements. This unique preparedness tool will help establish an easy conceptual framework for all healthcare providers to grasp the complex -clinical and non-clinical- processes of establishing new PICUs and develop a holistic approach to this complex project.
Note: The authors had leading roles in establishing or renovating many PICUs in Saudi Arabia, in both private and governmental hospitals, and would like to share their novel conceptual framework for establishing new PICUs in developing countries.
Background
The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19.
Methods
In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement.
Results
We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times.
Conclusions
The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.
An intensive care unit (ICU) is dedicated to caring for patients whose medical condition places them at high risk of mortality or serious morbidity. ICU medical devices (ICUMDs) are used to closely monitor, stabilize, and treat ICU patients who are often unconscious and rely almost solely on ICUMDs. ICUMDs have become more autonomous, with a range of components, connectivity to external devices, and functionalities, opening the door to cyber-attacks. We present a taxonomy based on the functionality of 19 widely used ICUMDs, providing an explanation of each device’s medical role, properties, interactions, and how they impact each other’s security. We provide an extensive survey of 16 possible attacks aimed at ICUMDs and assess each device’s vulnerability. We also create an ecosystem graph describing the roles and interactions of the players of each ICU sub-department. For each device type we produce a unique attack flow diagram that presents the most vulnerable vectors and components within the ecosystem. Finally, we survey relevant security mechanisms and map their coverage for the attacks, identifying existing gaps. We show that current security mechanisms generally fail to provide protection, covering just 12.5-56.3% of the attacks against ICUMDs, leaving the devices and the patients vulnerable.
This article studies the importance, requirements, and trends of synchronization for radio communications. Fifth-generation (5G) wireless communication is expected to be a forthcoming revolution in the wireless world, achieving communications with a high peak rate, high spectral efficiency, multiple device connectivity, low end-to-end latency, and high reliability. From a historical perspective, we review the synchronization required for first-generation (1G) to fourth-generation (4G) mobile communications to achieve performance metrics and provide various new services. New synchronization specifications and standards may depend on specific new applications and are, therefore, more service oriented. This article surveys the progress and trends of synchronization requirements in standardizations and specifications.
Mobile Health (mHealth) is on the rise and it is likely to reduce costs and
improve the quality of healthcare. It tightly intersects with the Internet
of Things (IoT) and comes with special challenges in terms of
interoperability and security. This paper focuses on security challenges
and offers a mitigation solution especially with a focus on authentication
and encryption for resource constrained devices. It identifies assets in a
prototyped mHealth ecosystem and classifies threats with the STRIDE
methodology. Furthermore the paper identifies associated risk levels using
DREAD and outlines possible mitigation strategies to provide a reasonable
trustworthy environment.
ENISA) is a centre of network and information security expertise for the EU, its member states, the private sector and Europe's citizens. ENISA works with these groups to develop advice and recommendations on good practice in information security. It assists EU member states in implementing relevant EU legislation and works to improve the resilience of Europe's critical information infrastructure and networks. ENISA seeks to enhance existing expertise in EU member states by supporting the development of cross-border communities committed to improving network and information security throughout the EU. More information about ENISA and its work can be found at www.enisa.europa.eu.
In a world where the industry of mobile applications is continuously expanding and new health care apps and devices are created every day, it is important to take special care of the collection and treatment of users’ personal health information. However, the appropriate methods to do this are not usually taken into account by apps designers and insecure applications are released. This paper presents a study of security and privacy in mHealth, focusing on three parts: a study of the existing laws regulating these aspects in the European Union and the United States, a review of the academic literature related to this topic, and a proposal of some recommendations for designers in order to create mobile health applications that satisfy the current security and privacy legislation. This paper will complement other standards and certifications about security and privacy and will suppose a quick guide for apps designers, developers and researchers.
Die pharmazeutische Industrie steht im deutschen Gesundheitswesen häufig im Mittelpunkt kontroverser Kostendiskussionen. Als Resultat zielten die Maßnamen der Gesundheitspolitik in den letzten Jahren vorrangig auf (Kosten-)regulierungen der Arzneimittelindustrie ab, deren bisheriger Höhepunkt die Einführung des AMNOG im Jahr 2011 darstellte. Die bis dato freie Preisbildung wurde abgelöst durch ein zweistufiges Verfahren bestehend aus Nutzenbewertung und Preisverhandlung. Diese gravierenden Veränderungen der gesetzlichen Rahmenbedingungen für die Arzneimittelindustrie hatten einen erheblichen Bedeutungszuwachs des Themas Market Access zur Folge. Die Motivation zur Erstellung des Buches ist es, eine Publikation zu schaffen, die nicht nur den aktuellen Status widerspiegelt, sondern vielmehr auch die wesentlichen Instrumente und Verfahrensweisen aufzeigt und auch kritisch hinterfragt. Der Leser soll so einen Einblick in die Materie als auch nötiges Rüstzeug bei der konkreten Umsetzung erlangen. Das Buch dient dazu, Market Access Managern oder Interessierten fundiertes Hintergrundwissen zu vermitteln.
Der Herausgeber
Prof. Dr. Ralph Tunder leitet das Health Care Management Institute an der EBS Universität für Wirtschaft und Recht in Wiesbaden. Seine Lehr- und Forschungsschwerpunkte liegen in den Bereichen der Geschäftsfeld- und Unternehmensstrategien von Gesundheitsdienstleistern und -unternehmen. Darüber hinaus leitet er seit 2011 als 1. Vorsitzender die Deutsche Fachgesellschaft für Market Access e.V. (DFGMA).
This book introduces the Process for Attack Simulation & Threat Analysis (PASTA) threat modeling methodology. It provides an introduction to various types of application threat modeling and introduces a risk-centric methodology aimed at applying security countermeasures that are commensurate to the possible impact that could be sustained from defined threat models, vulnerabilities, weaknesses, and attack patterns. This book describes how to apply application threat modeling as an advanced preventive form of security. The authors discuss the methodologies, tools, and case studies of successful application threat modeling techniques. Chapter 1 provides an overview of threat modeling, while Chapter 2 describes the objectives and benefits of threat modeling. Chapter 3 focuses on existing threat modeling approaches, and Chapter 4 discusses integrating threat modeling within the different types of Software Development Lifecycles (SDLCs). Threat modeling and risk management is the focus of Chapter 5. Chapter 6 and Chapter 7 examine Process for Attack Simulation and Threat Analysis (PASTA). Finally, Chapter 8 shows how to use the PASTA risk-centric threat modeling process to analyze the risks of specific threat agents targeting web applications. This chapter focuses specifically on the web application assets that include customer's confidential data and business critical functionality that the web application provides. Provides a detailed walkthrough of the PASTA methodology alongside software development activities, normally conducted via a standard SDLC process Offers precise steps to take when combating threats to businesses Examines real-life data breach incidents and lessons for risk management Risk Centric Threat Modeling: Process for Attack Simulation and Threat Analysis is a resource for software developers, architects, technical risk managers, and seasoned security professionals.
Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and "smart" intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.
Dieses Handbuch adressiert häufig anzutreffende Defizite und Probleme bei der Digitalisierung der Automobilindustrie und entwickelt einen methodisch fundierten und praxiserprobten Leitfaden zur agilen Umsetzung. Im Mittelpunkt steht der Wandel vom fahrzeugfokussierten hin zu einem mobilitätsorientierten Geschäftsmodell. Ausgehend von den Treibern des digitalen Wandels werden vier Digitalisierungsfelder definiert und eine Roadmap zu deren Transformation vorgestellt. Der Weg hin zur automatischen hoch effizienten Abwicklung von schlanken, integrierten Geschäftsprozessen wird ebenso erörtert wie die Beherrschung der massiven Veränderung von Vertriebs-, Aftersales- und Marketingstrukturen mit der Neugestaltung von Kundenbeziehungen. Die umfassende Veränderung der Unternehmenskultur sowie eine agile und effiziente Informationstechnologie werden als kritische Erfolgsfaktoren im Detail behandelt. Ausgewählte Praxisbeispiele für innovative Digitalisierungsprojekte vermitteln zusätzliche Ideen und Impulse.
Der InhaltZielsetzung, Rahmen des Buches - Entwicklung der Informationstechnologie als Digitalisierungstreiber - „Digital Lifestyle“ zukünftiger Mitarbeiter und Kunden - Technologien für Digitalisierungslösungen - Vision digitalisierte Automobilindustrie 2030 - Roadmap einer nachhaltigen Digitalisierung - Unternehmenskultur und Organisation - Informationstechnologie als Enabler der Digitalisierung - Beispiele innovativer Digitalisierungsprojekte in der Automobilindustrie - Auto-Mobilität 2040
Der Autor
Dr.-Ing. Uwe Winkelhake ist Vice President Automotive der IBM Deutschland GmbH und hat über 30 Jahre Berufserfahrung in der IT der Automobilindustrie mit großen internationalen Transformationsprojekten.
Mobile health technology has great potential to increase healthcare quality, expand access to services, reduce costs, and improve personal wellness and public health. However, mHealth also raises significant privacy and security challenges.
After reading, writing and arithmetic, the 4th ‘r’ of literacy is cyber-risk
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Whitepaper: 5G - Evolution oder Revolution?
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