Lessons learned from our MedIAM project

A project sponsored by EU's NGI TRUST

According to cybercrime magazine, “healthcare suffers 2-3X more cyberattacks than the average amount for other industries”, because the data has more value for hackers. Cyber regulations such as the EU cybersecurity act provide mandatory requirements to protect sensitive information and systems. Beyond traditional clinical systems of electronic health records (EHR), it remains really difficult to extend that line of requirements to connected devices people carry around as part of their treatments. If those medical devices aren’t properly secured, people may unknowingly be broadcasting their health status, as well as many other personal sensitive data, everywhere they go. Or even be directly harmed by hacked devices. Existing protocols available for IoT are unable to meet the complete requirements from regulators. In the current proposal, we provide an open source pilot implementation on how an equipment vendor should protect the functions and data of their medical IoT devices, and looked how to manage the identities of connected devices.

Keywords: entrepreneurship; digital identity; IoT; healthcare

As serial entrepreneurs, working on the next opportunity is a peculiar moment. The time when you can reflect on past experiences. When you get to figure out where you might make a difference, and where your efforts will be focused on for the next 10 years. That preliminary research is a lot of hard work, from new ideas to technical prototyping. Our open source project being sponsored by EU's next generation internet is a fantastic possibility to discuss with our peers and disseminate those findings.

During the pandemic, digital platforms have helped keep the population safer, for instance via the remote tracking of chronic respiratory diseases or other co-morbidities. This has led to an increase in the number of telehealth solutions and of medical devices being deployed in the field. We started by analyzing past security breaches.

The results show that healthcare boasts one of the highest average rates of severe security findings. Not all types of healthcare organizations share the same struggles. Because they’re still operating in closed legacy environments, hospitals are able to maintain their level of cyber hygiene, compared to ambulatory or nursing care facilities. In the current state of affairs, integrating with saas vendors or third-party connected medical equipment increases the risks, because most of them exhibit an inverted ratio for exposure relative to their internet surface area. The industry should therefore put more emphasis on privacy-and-security-by-design as an integral part of their duty of care. And it will. Because public regulators, both in Europe and overseas, have acknowledged the vulnerability of those sensitive information systems and data, with new requirements taking the force of law.

Despite those well established challenges, finding the right product-market fit has proven difficult. During our interviews with industry participants including CISOs, IT professionals, biomedical engineers, third-party vendors, healthcare professionals and patients, appeared a silo-ed approach to innovation. Most of the participants took improvement actions, but had the feeling of institutional resistance from their other counterparts. A way to reconcile those initiatives was to put medical efficiency at the center. People didn’t care much about network segmentation or machine identity, but were asking very pragmatic questions: what’s our inventory of medical equipment? are they well used and maintained? how can a remote maintenance process be integrated into the medical activities and how the various stakeholders, and the end-users in particular, would be involved and benefit from it? how do you handle the large majority of devices that can’t be updated? So we designed various experiments to test our hypotheses.


This had a profound impact on our technological choices. When implementing the security protocols, this helped us focus on a human-centric approach. Apart from those field discoveries, the project followed its course as planned. We implemented minimum viable product experiments, got accepted three peer reviewed research articles, published some dissemination blog articles, updated an upcoming IETF standard and published a patent.

The NGI Trust helped us a lot in our journey, as it offered great mentorship and advice from recognized experts, both on the technical and business perspectives. We also appreciated a lot the focus on how to build upon an open source strategy.

The public documentation is available at mediam