Review Not peer-reviewed version

Artificial Intelligence and Algorithmic

Approaches of Health Security Systems:
A Review

Constantinos Koutsojannis * and Savina Mariettou

Posted Date: 7 November 2024

doi: 10.20944/preprints202411.0526.v1

Keywords: Health Security; Data Protection; Cybersecurity in Healthcare; Algorithmic; Artificial Intelligence;
Approaches

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Review

Artificial Intelligence and Algorithmic Approaches of

Health Security Systems: A Review
Savina Mariettou 1, Constantinos Koutsojannis 2 and Vassilios Triantafillou 3,*

1 University of Peloponnese, Electrical and Computer Engineering Department, Patras, Greece

2 Professor of Medical Physics & Electrophysiology, Director of Health Physics & Computational Intelligence Laboratory,
Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
3 Professor of Network Technologies and Digital Transformation lab, Electrical and Computer Engineering Dpt.,

University of Peloponnese. Patras, Greece

* Correspondence: s.mariettou@go.uop.gr

Abstract: This paper explores the overall picture regarding security systems in healthcare through an extensive
review of the literature. As the healthcare sector has now become digitalized, the security of healthcare systems
and, by extension, the protection of patient data is a key concern in the modern era of technological advances.
Therefore, a secure and integrated system is now essential. Thus, to evaluate the relationship between security
systems and healthcare quality, we conducted literature research to identify studies reporting their association.
The timeline of our review is based on published studies covering the period from 2018 to 2024, with entries
identified through a search of the relevant literature, focusing on the most recent developments due to advances
in artificial intelligence and algorithmic approaches. Thirty-three studies were included in our final survey.
Our findings underscore the critical role of security systems in healthcare that significantly improve patient
outcomes and maintain the integrity of healthcare services. According to our approach, the studies analyzed
highlight the growing importance of advanced security frameworks, especially those incorporating artificial
intelligence and algorithmic methodologies, in safeguarding healthcare systems while enhancing patient care
quality. According to this study, most of the research analyzed uses algorithmic technology approaches, many
researchers prove that ransomware is the most common threat to hospital information systems, and more
studies are needed to evaluate the performance of the systems created against this attack.

Keywords: health security; data protection; cybersecurity in healthcare; algorithmic; artificial intelligence;
approaches

1. Introduction
The security of health systems and patient data is now one of the most critical issues in modern
medical technology [1]. The main reason why the healthcare sector is a target for cyber-attacks is the
constant movement of sensitive information and data [2]. The digitization of medical information,
transmission of patient data and the application of the Internet of Things (IoT) to healthcare services
offer new levels of efficiency and accessibility, improving the quality of patient care. However,
increased connectivity and widespread data storage raise significant security challenges [1]. Data
breaches in healthcare are a serious issue regulated by the HIPAA Privacy Rule. Some data breaches
can be due to human error, theft and data loss. Human error breaches have increased rapidly,
however theft and data corruption remain at high levels [3]. It is also important to note that in many
countries this issue of information systems security has been underestimated [4]. Despite the increase
in attacks, many healthcare organizations are still investing a small portion of their budget in
cybersecurity, which increases the likelihood of vulnerability [2]. The COVID-19 pandemic has
contributed significantly to the increase in cyberattacks targeting healthcare organizations, with the
most common threats including ransomware, fake accounts, phishing, disinformation campaigns,
and supply chain disruptions [5]. The increase in cyber-attacks in the healthcare sector in 2019 has
motivated many companies to test more innovative mechanisms and technologies to secure their
information systems such as Blockchain and Algorithmic Approaches.

© 2024 by the author(s). Distributed under a Creative Commons CC BY license.

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Delving a little deeper into these technologies, we have that Blockchain is a technology that uses
public key encryption for authentication and records every transaction on a network. Every
transaction that takes place cannot be modified once it is completed. Each network has nodes. All
nodes record transaction information in blocks in chronological order, and each new block is
connected to the previous one, thus creating a chain. This structure allows data to be kept secure.
This security serves the system well as if an attacker who would like to compromise one block would
have to compromise the entire chain. The blockchain uses hashing algorithms, which make any
attempt to tamper or tamper with the data detectable. Each node communicates with the other nodes
in the network and can publish/transmit information. To prevent tampering, a consensus mechanism
is in place to ensure the reliability of the information. The block is completed by validating the
information created on a network. Therefore, when the information is validated, it is packed into a
new block and added to the chain. Note that nodes working in the consensus process are motivated
to do so. They are usually rewarded financially for their contribution to the security and stability of
the network. The public blockchain, due to its complete decentralization, uses cryptography and
consensus mechanisms, such as proof of work or proof of ownership, to ensure the reliability and
security of its data [6]. All the above can be seen in Figure 1 which represents a Blockchain transaction.
The nodes or users agree to a transaction [7].

Figure 1. Visual representation of a blockchain transaction [7], reproduced without modifications.

Similarly, Algorithmic Approaches are key tools in Health Security Systems, as they enable the
accurate matching of patients with their health information. By using demographic information such
as first name, last name, gender, date of birth, social security number and address, algorithms ensure
the integrity and reliability of patient data. Techniques range from simple, deterministic approaches,
where a unique identifier is compared with a few non-unique attributes, to more complex
probabilistic matching techniques that use thresholds. The contribution of algorithmic approaches to
health security systems is vital, as they allow for the secure management of patient data despite any
errors or missing data. However, algorithmic design remains a challenge due to variables, such as
inaccurate demographic information and data heterogeneity, that can reduce accuracy [8].
The aim of this article is to highlight the current situation regarding the security of healthcare
systems, with the goal of improving existing systems to enhance the quality of care for patients.
The article is organized as follows: in Section 2, a detailed analysis of the 33 identified security
systems is performed. In Section 3, the methods used to identify and evaluate these systems are
described. In Section 4, we present the findings of our study, while Section 5 presents the main
conclusions and recommendations for future research.

2. Overview of Health Security Systems

In the era of digitalization, threats to the security of healthcare systems have significantly
increased. Examples such as the creation of fake medical data, such as the introduction of fictitious
conditions (e.g., fake tumors) or high-profile diseases (AIDS, SARS, Ebola) into diagnostic records,
are serious threats that can mislead the medical community and lead to incorrect treatments.
Researchers in Israel have developed a virus that can insert fake tumor data into CT and MRI scans,
misleading doctors into erroneous diagnoses [5]. This threat is particularly alarming, as the security
of medical data, including images and associated records, is critical for the accuracy of diagnoses and
the effectiveness of treatment. The PACS (Picture Archiving and Communication System), which is
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used to store and manage medical data, exhibits vulnerabilities since it is connected to various
networks and systems. This creates a large attack surface, allowing malicious users to compromise
data and gain access to other critical health information. This makes the security of medical data
essential for maintaining the integrity of diagnoses and patient care. An extensive literature review
follows, documenting various security systems developed to protect against such threats. Through a
detailed examination of these systems, their descriptions, summaries, and the attacks they mitigate,
we demonstrate how security remains paramount to the integrity of diagnoses and safe patient care.

Table 1. Comprehensive Analysis of Health Security Systems.

Author(s) Security System Synopsis Mitigated Attacks

It operates using three-factor authentication to
securely verify remote users in WMSNs
environments. Additionally, it has been validated Unauthorized Access,
WMSNs (Wireless Medical
[9] using Burrows–Abadi–Needham (BAN) logic Offline Password
Sensor Networks)
and the Automated Validation of Internet Guessing Attacks
Security Protocols and Applications (AVISPA)
tool.
The proposed IDS is designed to detect network
IDS (Intrusion Detection intrusions while minimizing the load on
[10] Man-in-the-Middle
System) resource-constrained sensors, enhancing security
without overburdening limited-capacity devices.
Μodified deep learning The system uses deep learning and CPS for
approach based on Cyber secure processing of IoT data, providing
DoS (Denial of service),
Physical Systems (CPS) protection against DoS and DDoS attacks, with
[11] DDoS (Distributed
98.2% accuracy and improved performance
Denial of Service)
compared to existing models such as LSTM and
CNN.
BioCryptosystem It enhances the security of biometric data by
using FaceHashing with BioCrypto-Circuit and
[12] Unauthorized Access
BioCrypto-Protection techniques, offering robust
protection against external attacks and misuse.
Energy-Efficient Routing This protocol enhances security and energy
Protocol (ECC-EERP) efficiency in Internet of Medical Things (IoMT)
applications by employing elliptic curve
[13] -
cryptography for secure data transmission while
minimizing energy consumption and
communication overload.
[14] N-IDS (Network- Intrusion This system detects intrusions and attacks in a KISTI Network
Detection System) smart healthcare system using a deep learning Payload Dataset,
approach that combines CNN (Convolutional KDDCup-99, UNSW-
Neural Networks) and LSTM (Long Short-Term NB15, CICIDS-2017,
Memory) to extract optimal features from WSN-DS
network data and detect attacks with high
accuracy.
Blockchain Modern security systems enhance medical data Man-in-the-Middle,
privacy, integrity, and access control in DDoS (Distributed
healthcare, enabling secure management of Denial of Service),
patient records, IoT (Internet of Things) devices, Single Point of Failure,
[15–26]
and remote healthcare systems. Data Tampering,
Unauthorized Access,
Tampering Attacks,
Data Breach,
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Counterfeit Product
Attacks
[1] LRO-S encryption method It combines lion and remora optimization with Privacy Breaches,
serpent encryption to secure medical data, Unauthorized Access
offering enhanced protection against cyber-
attacks and privacy breaches, with improved
encryption/decryption time and performance
compared to existing methods.
[27] QP-CNN (Quantum The QP-CNN enhances the security of AI-based DoS (Denial of service),
Photonic Convolutional healthcare systems by utilizing quantum Stolen Device,
Neural Network) photonic computation for the encryption and Untraceability/
protection of patient data during transmission Anonymity, Replay,
and storage. The study demonstrates its Man-in-the-Middle,
effectiveness through simulations, achieving high Impersonation,
accuracy and various performance metrics. Temporary Secret
Leakage Attack
[28] CMTL (Centralized Multi- The "EoT-TL Healthcare" system combines edge DoS (Denial of service),
Source Transfer Learning) computing, Internet of Things, blockchain, and DDoS (Distributed De-
cloud technologies for cyberattack detection and nial of Service),
data security optimization in healthcare, with Malware, Injection,
high performance evaluated using three datasets. Man-in-the-Middle
[29] Cryptosystem with SHA-256 It uses DNA encoding, SHA-256, and HCMACS Statistical, Differential,
and Hyper Chaotic Multi for secure medical image encryption, providing Chosen-Plaintext
Attractors Chen System protection against statistical, differential, and
brute-force attacks, while ensuring the
confidentiality, integrity, and availability of data.
[30] Encryption technique It uses genetic encryption for secure transmission Blackhole, Selective
of health data via wireless sensors, while Forwarding, Sybil,
incorporating an authentication process for user Hello Flood
verification and preventing malicious attacks.
[31] Zero-watermarking Uses deep learning and specialized image Signal Interference,
processing techniques to secretly embed a Spatial Manipulation,
distinguishing mark in medical images. This Communication
prevents unauthorized access or distribution, Protocol Vulnerabilities
ensuring the protection and integrity of
healthcare records.
[32] PAAF-SHS (Physical The PAAF-SHS provides secure encrypted Stolen Device, DoS
Unclonable Authentication communication between users and medical (Denial of service),
Function - Smart Healthcare servers using mutual authentication and PUF Replay Attack, Man-in-
Systems) technology. the-Middle, Phishing,
Impersonation, Key
Compromise, Insider
Threats
[33] Decentralized Adaptive Dynamically adapts security solutions in real-
Security Architecture time to address the constraints of Internet of
Medical Things (IoMT) devices, ensuring the -
protection of data through the implementation of
the edge-cloud continuum.
[34] CLM-based ECG Encryption The system utilizes the Chaotic Logistic Map Noise-based attacks,
System (CLM) and fingerprint data to encrypt ECG Hacking attacks
signals, thereby ensuring secure transmission
over the internet.
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Encryption Framework for The system utilizes ECG signals and a

Secure Telehealth and lightweight encryption algorithm to securely
[35] Electronic Health Records transmit electronic health records (EHR) in -
(EHR) telehealth applications, ensuring enhanced data
privacy, confidentiality, and access control.
[36] IEDF (Intelligent Encryption It combines the AES, DES, RSA, and Modified Data Breaches
and Decryption Framework) Blowfish (MBF) algorithms for cloud data
security, using Automatic Sequence
Cryptography (ASC) for efficient and secure data
block encryption.
[37] WSNs (Wireless Healthcare This protocol enhances the security of wireless User Impersonation,
Sensor Networks) sensor networks used in healthcare by Offline Password
implementing a three-factor authentication Guessing Attack,
strategy that incorporates user identity, Insider Attack, Device
password, and biometric data. It ensures robust Stolen, GWN
mutual authentication and protects against Bypassing Attack, DoS
various potential attacks. Formally verified using (Denial of service),
the ProVerif tool.
[38] Image Encryption The Deep Learning-Based Image Encryption Unauthorized Access,
Framework Framework employs ResNet-50 to secure medical Data Breaches, DoS
images through encryption and decryption, (Denial of ser-vice),
effectively addressing cyber threats and ensuring Impersonation Attacks,
the confidentiality and integrity of sensitive Replay Attacks
patient data.
[39] Chaos-Based Lightweight Its 4-scroll chaotic attractor securely encrypts Unauthorized Access,
Encryption Scheme health data, particularly from wearable devices. Data Breaches, Known-
It ensures confidentiality and integrity while Plaintext, Chosen-
maintaining real-time processing. The method Plaintext Attacks
has demonstrated strong resistance to known
and chosen plaintext attacks, supported by a
large key space and adequate throughput.
[40] Standard-Based Approach It utilizes standards such as COSMIC ISO/IEC Unauthorized Access,
19761 to design a secure healthcare system Data Breaches,
architecture. This method combines system and Ransomware,
software security requirements, employing Tampering, Data
features like access control, data encryption, and Corruption
auditability to mitigate vulnerabilities and
protect against unauthorized access.

3. Materials and Methods

For this review article, a comprehensive search was conducted covering the period from
01/02/2024 until 30/09/2024 in major databases, on published medical literature using several
electronic databases including Pubmed, Google Scholar, MDPI, IEEE, ScienceDirect. The research
used keywords such as health security system, artificial intelligence in healthcare, health data
protection, cybersecurity in healthcare, cyberattacks in healthcare.
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Figure 2. Flowchart of our research approach.

4. Results
After a thorough study of modern security systems, as presented in Table 1, all systems focus on
security in the collection and transmission of patient data, with the main objective of protecting
against attacks in the healthcare sector. The technologies used in this area focus on maintaining data
privacy and integrity without affecting the performance of devices or networks. Most of the research
analyzed use algorithmic technology approaches. In terms of key threats, Selvarajan & Mouratidis
(2023) highlight unauthorized access, where attackers attempt to gain access to data without
permission. DoS attacks, which disrupt services by overloading the network with fake requests, and
man-in-the-middle attacks, in which the attacker gains control of the communication, are also critical
[26]. As noted by Javaid et al. (2023), and many other researchers, ransomware attacks are widely
prevalent. However, only in the study by Abusal et al. (2024) were they considered a significant threat
and thoroughly analyzed within the context of overall security threats. Anand et al. (2024) analyzes
the resilience of the proposed system through three main attack categories: Noise Removal,
Geometry, and Protocol. In the Noise Removal category, the attacks include various types of noise
such as Gaussian noise, while in the geometry category, attacks such as JPEG Compression, Zoom,
and Rotation are considered. Finally, Ravi (2023) presents the performance of the N-IDS intrusion
detection system on various datasets.

4.1. Security Systems Based on Blockchain Approaches

We note in Table 1 that Blockchain-based systems have been extensively studied by many
authors. At this point, we would like to add some additional information that was considered
important for a better understanding and evaluation of these systems.
The security system proposed by Tariq et al. (2020), known as Blockchain-based Security
Solution for IoT-enabled Smart Healthcare Systems, uses blockchain for distributed, scalable, and
efficient management of medical transactions, with immutable records. The system by Puri et al.
(2021) offers decentralized patient data management using AI and blockchain. It targets transparency
through smart contracts and includes mechanisms to detect malicious IoT devices, improving energy
consumption, response time, and transaction delays. The system proposed by Abid et al. (2022) offers
decentralized access for IoT devices using smart contracts and the Generalized Temporal Role Based
Access Control (GTRBAC) model for detailed access policy with time constraints. Experimental
evaluation showed low gas cost and low latency. The application developed by Sharma et al. (2023)
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uses blockchain to manage medical certificates via smart contracts. The system, deployed on
Ethereum, offers transaction cost and efficiency analysis, including gas consumption and processing
time. Consultative Transaction Key Generation and Management (CTKGM), proposed by Selvarajan
& Mouratidis (2023), uses blockchain to generate cryptographic key pairs and the Quantum Trust
Reconciliation Agreement model (QTRAM) for trust evaluation. The Tuna Swarm Optimization
(TSO) method verifies nonce messages, ensuring authenticity and efficient data transmission. The
IoT-based Distributed Healthcare Framework with Blockchain and AI-based Smart Contracts,
proposed by Rani et al. (2023), offers a distributed framework for remote healthcare services, using
Distributed Database Management System (DDBMS) and blockchain for data storage and processing,
with high-performance evaluation. The solution proposed by Akinola et al. (2024) integrates
blockchain with cryptographic techniques such as hashing and digital signatures for medical devices,
using Proof-of-Work and Proof-of-Stake consensus mechanisms. The system complies with HIPAA
and GDPR standards. Mohammed et al.'s (2024) Pattern-Proof Malware Validation (PoPMV) is a
blockchain-based system for malware validation in microservice flows. No specific attack scenarios
were reported in the experimental evaluation. The system proposed by Liu et al. (2024) is based on
blockchain and 6G and consists of two layers: the Sensing Communication Layer (SenCom-Layer)
and the Blockchain Layer (BlockC-Layer). An energy-efficient algorithm is applied to the SenCom-
Layer, while the BlockC-Layer uses cooperative gaming for energy efficiency. The system developed
by Wu et al. (2024) uses the Hyperledger Composer platform to manage the implant supply chain.
Although no specific attacks were tested, the use of blockchain and hybrid encryption offers increased
security. The IoMT-Fog-Blockchain with IPFS Framework, proposed by Mallick et al. (2024),
integrates IoMT, Fog Computing, Blockchain, and IPFS for decentralized medical data management.
The system offers scalable searches and stores data hashes on the blockchain, while the use of Elliptic
Curve Digital Signature Algorithm (ECDSA) protects against forgery. Blockchain-based Attribute-
Based Access Control (ABAC) with anonymous authentication, developed by Idrissi & Palmieri
(2024), combines mobile agents and blockchain for mutual authentication and access control (ABAC)
in IoT-based healthcare systems. Elliptic Curve Cryptography (ECC) encryption offers fast key
agreement, while the system has low communication costs and reduced computational load.

4.2. Attack Types and Mitigation Strategies

At this point, it is necessary to describe the types of attacks listed in Table 1, to facilitate the
understanding of their nature and the data they seek to intercept through specific methods. However,
before being analyzed in detail, it is worth noting that systems that do not include specific
information in the Mitigated Attacks field were examined separately, to clarify their effectiveness and
the attacks they can mitigate more accurately.
Initially, the ECC-EERP system has been evaluated against other existing methods, showing
improved security, high encryption efficiency (99%), increased energy efficiency, longer network
lifetime, and lower computational cost. The present scheme demonstrates significant superiority in
critical parameters such as security, encryption performance, communication overload reduction,
and processing time efficiency, outperforming other existing methods [13]. Regarding the
Decentralized Adaptive Security Architecture scheme, no specific details on experimental studies or
results confirming the effectiveness of the proposed security architecture are provided. Instead, the
emphasis is on describing the architecture and the challenges faced by digital healthcare systems,
elements that provide important insights relevant to this work [33]. Finally, the Encryption
Framework for Secure Telehealth and Electronic Health Records (EHR) system was not specifically
tested for more complex attacks, such as DDoS or man-in-the-middle, but focused on Functional
Testing and performance testing. Despite limited security testing, it was deemed worthy of inclusion
in this work due to its overall performance evaluation [35].
Completing the analysis of the security systems that did not have a specific attack, the
terminology of the others follows to better understand the potential risks that threaten health systems
and patient data.
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1. Man-in-the-middle (Middleman Attack): the attacker interferes with the communication

between two parties, trying to obtain or alter information. The security of key agreement and
authentication protocols is verified through the AVISPA tool [26].
2. DoS (Denial of Service): Attackers flood the medical server with numerous requests,
overwhelming its resources and substantially slowing down or crashing the system, which
compromises the availability of medical services [32].
3. Blackhole Attack: in this attack, a malicious node interferes with the flow of data by redirecting
it to a blank spot and preventing proper transmission in the network [30].
4. Selective Forwarding Attack: during this attack, selected data packets - often of a sensitive
nature - are dropped by sensors, disrupting the information flow [30].
5. Sybil Attack: a malicious node pretends to be multiple different nodes, illegally gaining access
to the network and causing a security risk [30].
6. Hello Flood Attack: this is an attack where a node sends fake Hello packets, disrupting the
communication flow and causing confusion in data transmission [30].
7. Privacy Leakage: It involves the loss of sensitive data, mainly due to inadequate protection
measures [15].
8. Tampering (Data Tampering): Malicious users tamper with medical records, affecting the
reliability of the data [15].
9. Forgery: Malicious attempts to create fake medical data or transactions for fraudulent purposes
[15].
10. Single Point of Failure: In traditional systems, there is a central point of vulnerability that can
cause total system failure [15].
11. Data tampering attacks: they focus on data tampering. The blockchain ensures integrity by
preventing tampering [26].
12. Forgery attacks: Attempts to create false data. ECC and mobile agents offer protection [26].
13. Privacy violation attacks: Revealing personal data. Anonymous authentication protects the
personal data of patients and professionals [26].
14. Data breach: unauthorized individuals gain access to sensitive information through attacks such
as hacking or phishing, causing damage to personal and financial data [36].
15. DDoS (Distributed Denial of Service): Coordinated attacks by multiple compromised devices,
or a botnet, flood a system with excessive traffic, rendering it inoperative and denying service
to legitimate users. This widespread disruption critically affects the availability of medical
services [41].
16. Ransomware: A type of malware that encrypts a victim's files, demanding a ransom payment
for the decryption key. This malware exploits the critical nature of personal and business data,
forcing victims to pay to regain access. Ransomware attacks can severely disrupt operations and
result in substantial financial and data losses, underlining the importance of robust
cybersecurity measures to protect sensitive information [42].
Other types of attacks can be identified, but the most important thing is that research should
focus on the effectiveness against different attacks. It is also important that the functionality of
hospital information systems is tested and adapted to new data.

4.3. Ransomware
Ransomware (ransom + malware) is a form of malware that aims to encrypt user or organization
files, demanding payment to restore access to them. This attack has been described as the most
common in the healthcare sector. The attack starts when the user opens a malicious link or attachment
in an email, installing the ransomware on their system. As the files are encrypted, a warning appears
asking for a ransom, threatening to delete the data or increase the required amount if payment is not
made within a certain deadline. Through this digital extortion tactic, many users are forced to pay to
recover their data [43].
From the analysis of the lifecycle of ransomware attacks, seven main stages can be observed:
Planning, Proliferation, Arrival, Control Communication, User Information Retrieval, Encryption and
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Extortion, and Financial Claims. The cycle begins with the creation and deployment of ransomware,
leveraging tools such as Ransomware-as-a-Service (RaaS). This is followed by propagation through
various social engineering attacks. Once the malware reaches the victim's device, it communicates
with a remote-control server to obtain the encryption key. It then seeks critical files for encryption
and, in the final stage, demands a ransom from the victim to restore the files [44].

Figure 3. Ransomware Attack Lifecycle [44], reproduced without modifications.

We focused on the ransomware attack as the healthcare industry is particularly vulnerable to

attacks of this type due to the retention of high-value sensitive data, such as medical and personal
records, making organizations high-value targets. Cybercriminals can use the stolen data for
extortion or resell it on the black market, where it is more lucrative than financial data. In addition,
inadequate training of employees in threat detection and generally poor cybersecurity infrastructure
exacerbates the problem, while the widespread use of Internet of Medical Things (IoMT) devices
increases network vulnerabilities, making them easier targets [45].

5. Discussion and Conclusions

In summary, this study has highlighted the importance of cutting-edge technologies, such as
blockchain, multi-factor authentication methods, as well as artificial intelligence techniques and
algorithmic approaches, which contribute to enhanced protection against attacks and ensuring data
confidentiality in the healthcare sector [40]. The protection of medical data is critical not only because
of its nature - as it includes sensitive personal information that, if leaked, can lead to serious
consequences - but also because it contributes to improving the quality of patient care. An
information system that works efficiently and with enhanced security measures offers significant
benefits to the overall improvement of patients' quality of life. Despite the plethora of proposed
security systems, we observed that many of them have not undergone experimental testing to assess
their resilience against insider attacks. In our study, we excluded all systems that had not been
experimentally evaluated, except for three publications that stood out due to the complexity and
novelty of their architecture [39]. These cases deserve further analysis and evaluation of their security
performance in the future. It is also important to note that while ransomware attacks have been
identified as one of the most frequent and serious threats, only one publication evaluated the
resilience of the proposed architecture against this threat. More work is needed in this direction.

6. Future Work
As future work, it is proposed to further extensive study the effectiveness of security systems,
with a focus on threats such as ransomware. In addition, it is proposed to develop a simulated
intelligence system that will be subjected to controlled attacks, including ransomware attacks. Data
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10

security solutions will enable deeper visibility and effective threat detection and response, while
ensuring real-time compliance. The integration of both artificial intelligence and algorithmic
approaches into healthcare security systems offers a new level of dynamism, enabling real-time threat
detection and threat response with accuracy and efficiency [40]. The superiority of either approach is
too early to measure. An effective benchmarking approach for these systems needs longer periods of
use and extensive operational data [4].

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