Keep an eye on your personal belongings! The security of personal medical devices and their ecosystems

Today, personal medical devices (PMDs) play an increasingly important role in healthcare ecosystems as patient life support equipment. As a result of technological advances, PMDs now encompass many components and functionalities that open the door to a variety of cyber-attacks. In this paper we present a taxonomy of ten widely-used PMDs based on the five diseases they were designed to treat. We also provide a comprehensive survey that covers 17 possible attacks aimed at PMDs, as well as the attacks' building blocks. For each PMD type, we create an ecosystem and data and attack flow diagram, which comprehensively describes the roles and interactions of the players associated with the PMD and presents the most vulnerable vectors and components within the PMDs' ecosystems; such knowledge can increase security awareness among PMD users and their healthcare providers. We also present the basic, yet important, building blocks that constitute the steps by which each of the attacks presented is carried out. Doing so allowed us to establish the foundations for the future development of a novel risk analysis methodology for medical devices. For each attack we mapped the building blocks required to carry out the attack and found that 50% of the attacks rely upon the ability to remotely connect to the PMD, while 61% of them rely on the physical proximity of the attacker to the PMD. Finally, by surveying 21 existing security mechanisms and mapping their coverage for the attacks, we identify the gaps between PMDs' security mechanisms and the possible attacks. We show that current security mechanisms generally fail to provide protection from all of the attacks against PMDs and suggest the development of a comprehensive framework to secure PMDs and protect the patients that rely upon them.