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Using digital records, telehealth, and Internet-linked devices is becoming more common in healthcare, so making sure API communication is safe and standardised is vital. The study is designed to analyse how well API gateways work, how secure they are and how compliant they are when using JSON Web Tokens (JWT) and OAuth 2.0 with healthcare systems. Secondary data, along with facts from case studies (such as NHS Digital and Babylon Health), were selected for the project to analyse the function of IoT, the storage of tokens and compliance with laws and regulations. Results revealed stronger access control, less risk and better compliance with GDPR and HIPAA. It states that using secure API setups, educating personnel and introducing standard security rules are important for tackling existing issues and getting healthcare systems ready for the future.
As digital health records, telemedicine, and IoT in medical devices are increasingly utilised today, healthcare systems now require more secure, flexible, and integrated ways to share data [1]. It is mostly through Application Programming Interfaces (APIs) that different healthcare platforms can communicate with each other. Even so, when devices and networks connect more, the risks of unauthorised entry and data leaks become more common. To maintain the security and compliance of exchanged health information, companies should consider strict authentication and authorisation features such as JSON Web Tokens (JWT) and Open Authorisation (OAuth 2.0).
This project investigates how JWT and OAuth are applied in API gateways to secure healthcare systems. JWT is recommended for stateless identity authentication, whereas OAuth lets users give apps permission without disclosing their login details, which adds more safety and privacy [2]. They cooperate to create a strong fence against usual cyber threats such as token hijacking, being attacked by a man-in-the-middle and unapproved entry to systems. It is being looked at to see that services are in line with the “Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR)” standards as they attempt to increase the security of networks and healthcare systems.
Many healthcare systems still lack secure and standardised “Application Programming Interfaces (API)” protections due to the digital shift, which makes patient data more vulnerable to cybercriminals [3]. Many authentication systems are not strong enough to manage security for connections between different platforms and third parties. Because gateway solutions are few and do not cover JWT and OAuth, there are problems and risks in managing healthcare data.
The primary goals of this project are: 1. To examine current API security challenges in healthcare information systems. 2. To explore the architecture and functionality of JWT and OAuth in enforcing a secure API process. 3. To design a prototype secure API gateway integrating JWT and OAuth protocols. 4. To assess the security performance and compliance benefits of the proposed implementation in real-world healthcare scenarios. This study aims to evaluate and implement secure API gateway frameworks utilising JWT and OAuth for enhancing data protection and controlled access in healthcare systems.
The scope of this project shows Healthcare IT systems requiring integration with other software, mobile apps and platforms for sharing patient information are under study. It is significant because it increases the privacy, accuracy and availability of health information. Global data protection standards help the findings suggest steps to secure APIs, reduce risks and increase trust in healthcare IT systems [4].
Figure 1: Security challenges in healthcare[5]
Figure 1 shows Key threats to API security in the healthcare industry, which come from malicious employees, outside hackers and third parties targeting EHR systems, FHIR APIs and patient records, so it is important to use secure gateways through the JWT and OAuth protocols [5]. Relying on digital technologies in healthcare has made a lot of API security issues more obvious. The use of APIs helps different systems like electronic health records (EHRs), mobile health apps and telemedicine platforms communicate with each other. But since many healthcare APIs have weak security features, there is a risk of unauthorised access, leaks of private health information and data breaches. One frequent problem is trying to integrate recent APIs with older systems that were not built to prevent today’s cybersecurity dangers. As well, not all healthcare providers following the same security processes lead to gaps in their security arrangements [6]. It is common in the literature to emphasise that centralised and standardised security is very important for APIs, but in the real world, many firms still depend on old forms of authentication.
Security experts widely accept JWT and OAuth as important tools for strengthening security when accessing APIs across different systems [7]. JWT makes it possible to do stateless authentication by storing user identity and pertinent information in a token, thus not requiring server-side storage. OAuth enhances this by supplying delegated access control, so users can let applications use their data without providing their full login information. Because JWT and OAuth work together, healthcare systems can ensure everyone has secure, efficient and scalable access, especially in environments with many users and systems. But the literature also highlights a number of limitations [8]. Problems with how tokens are managed, short expiration periods and issues with token revocation can cause possible weaknesses. There is not enough discussion on using JWT and OAuth in healthcare, and case studies to evaluate these protocols in sensitive clinical environments are often lacking.
Figure 2: Design of the overall framework of the security mechanism [9]
Figure 2 highlights a secure setup where data from users goes from the front-end to the gateway, shielded by mixed encryption (RSA for key exchange and AES for faster encryption). With this layered system, JWT and OAuth are added for better API security and authentication in healthcare [9]. Enforcing security policies through API gateways is very important for managing several healthcare services. They act as the main location for handling authentication, authorisation, controlling traffic and validating requests. API gateways can block unauthorised access to resources by using JWT and OAuth together. Numerous works on the subject talk about the ways different architectural styles guide the management of security rules [10]. However, details about these architectures meeting the immediate and always-on needs found in healthcare are not well established. Some API gateway designs do not include commonly used healthcare data standards such as Health Level 7 (HL7) and Fast Healthcare Interoperability Resources (FHIR).
The success of secured API systems in healthcare depends on their power, their careful handling of data and their complete adherence to regulations [11]. If healthcare providers use JWT and OAuth with their API gateways, secure and prompt control over access to data is possible, thus decreasing the risk of data breaches. Checking response time, validation of tokens and availability helps guarantee a smooth system. It is necessary to keep checking compliance with GDPR, HIPAA and the NHS DSP Toolkit to continue meeting all necessary laws and ethical rules [12]. But fewer studies address testing and viewing actual practices in healthcare security, which has become a gap in this research field.
In this study, the explanatory research design is used to look into how using JWT and OAuth to secure an API gateway increases data security and improves access control in healthcare. The idea is to show how better authentication makes systems work more smoothly, communicate better with each other and comply with digital healthcare regulations. It also plays a role in deciphering how security frameworks impact data exchange among healthcare apps right away.
This paper employed secondary sources to collect data, incorporating sources that use both qualitative and quantitative information. There are many types of qualitative data, such as academic journals, industry papers, technical documentation and case studies, all about healthcare cybersecurity, API handling and the use of JWT/OAuth. The quantitative group will use statistics, reports and compliance inspections to monitor how API security methods affect data breaches, the speed of accessing information and successful user authentication. Both approaches together give a thorough analysis of theories and how they are used in the real world.
Case study 1: NHS Digital- Spine Integration Platform
Competent improvements in Spine Integration Platform security (from 2020 until 2023) allowed the nationwide use of patient services such as the Summary Care Record [13]. It made sure to add OAuth 2.0 for allowing users to access resources using permission slips and JWTs forlogging in with tokens [13]. So these healthcare applications, pharmacies and permitted third parties could get access to patients’ confidential records without saving user passwords, which helped them follow the NHS Data Security and Protection Toolkit (DSPT) rules.
Case study 2: Babylon Health- Secure API for Telehealth
Between 2021 and 2023, Babylon Health in the UK started using JWT and OAuth protocols in its API gateway [14]. By doing this, the healthcare company added greater security to how its AI could access data through mobile apps and manage appointments. With the token expiration strategy in place, persistent sessions became less risky, which made user data safer to process and compatible with the GDPR.
Case study 3: EMIS Health- cloud integration with third-party apps
In 2022, EMIS Health made its cloud-based services stronger by introducing an API gateway that lets third-party applications use JWT and OAuth for secure connections. Because of this, it became much easier for the systems to communicate securely [15]. The API gateway, the company could provide stricter access controls and constant token review, which reduced many attempted unauthorised access and was compliant with the UK’s Cyber Essentials Plus requirements.
Healthcare systems examine secure API gateways using JWT and OAuth by measuring authentication pass rates, time required for a response and overall token validation [16]. Other metrics to monitor are successful breach reduction, following regulations such as GDPR and the NHS DSP Toolkit and how much time the system is functioning correctly. User access logs and security incident reports will also be looked at to judge whether there are improvements in controlling access and protecting data. They give information about the technical elements and any regulations affecting the whole system
Figure 3: Healthcare expenditure in the UK [17]
This graph shows how the total yearly healthcare spending in the UK has increased from 1998 to 2020. From 1998 to 2014, the expenditure had ups and downs. From 2001 to 2006, it was roughly 9.0% [17]. The rise in revenue from 2018 to 2020 was very sharp. GDP grew by around 5.0% in 2018, and the next year it rose to about 6.5%. But in 2020, the debt rate went up to 19.5%, most likely because spending related to COVID-19 was an emergency [17]. This new financial strain points out the need for better online systems, which is why using secure API gateways with JWT and OAuth becomes critical to handle healthcare transactions during such situations.
Figure 4: Healthcare deal activity grew[18]
There is an obvious trend of rising investment activity in healthcare from 2001 to 2021 in the “Global healthcare buyout deal count” graph. As healthcare buyouts are increasing, this trend fits well with the discussion on securing API gateways since more digital solutions, sharing of medical data and improved cybersecurity are now needed. The total number of deals in 2001 was only 54 [18]. By this time, the number had gone up to 236 because investors were gaining more confidence in healthcare. The number of deals went down to 142 in 2009, probably caused by the global financial crisis, but after that, it kept rising, reaching 265 in 2017 and peaking at 515 in 2021 [18]. This surge from 2016 shows up alongside the introduction of innovative digital health tools such as EHRs, telehealth and mobile apps, most of which owe their success to APIs. When more deals were done in North America, Europe, Asia-Pacific and the rest of the world, data breaches became more likely which emphasized the need for secure API gateways. JWT and OAuth are solutions that let secure patient data even as the healthcare industry worldwide grows and shifts to using technology.
As shown in Figure 3, healthcare spending went up sharply, with a significant peak of 19.5% of GDP in 2020, mostly related to forming a response to the COVID-19 pandemic [17]. Such a growth in online activities clearly points out the need for better digital infrastructure. It can be seen from Figure 4 that over the years, the number of global healthcare buyout deals increased from 54 to 515, suggesting more confidence among investors and new technologies used in the field [18]. Because of growing use of digital medical tools, organizations need to improve API security. They prove that it is now important to use security best practices with JWT and OAuth in healthcare APIs under both finance and technology stresses.
|
Case study |
Key outcomes |
Relevance to the present study |
|
Case study 1: NHS Digital- Spine Integration Platform |
Improved security and easier compliance with OAuth 2.0 and JWT; made the API easier to grow [13]. |
Shows how using tokens for security improves the safety of large healthcare platforms. |
|
Case study 2: Babylon Health- Secure API for Telehealth |
Integrate telehealth APIs safely; make sure attacks like session hijacking cannot succeed and remain GDPR compliant. |
Show how JWT and OAuth improve safety in mobile health and support contact between patients [14]. |
|
Case study 3: EMIS Health- cloud integration with third-party apps |
Offered support for API gateways, allowing users to connect securely with third parties; enhanced access management [15]. |
Shows how API gateways help keep data safe when in use with partners or users not part of the organisation. |
Table 1: Case study outcomes
(Source: Self-Created)
The table shows the results from three healthcare studies in the UK that have used JWT and OAuth to control API access. This explains why each outcome is considered by showing how real-life examples help to achieve the main aim of making healthcare data safer and easier to use.
|
Author |
Focus |
Key Findings |
Gaps |
|
[5] |
Threats in healthcare |
Gateways must be secure because of malicious insiders and third-party risks [5]. |
Not enough effort is spent on inventing new and improved prevention strategies |
|
[6] |
Legacy system integration |
Vulnerabilities in the API security caused by outdated organisational systems |
There is not a single standard for security throughout the industry [6]. |
|
[7] |
JWT and OAuth principles |
Provides a way to control access in a scalable, stateless and delegated manner |
Not having particular examples about healthcare. |
|
[8] |
Token management flaws |
Provides information about how to use or cancel accounts once they reach their limits [8]. |
Only little research has been done on real-time healthcare systems. |
|
[9] |
API gateway encryption |
Using Mixed RSA-AES with OAuth/JWT makes security stronger [9]. |
Does not support HL7 or FHIR standards |
|
[10] |
Policy enforcement through API gateways |
Management of security is made easier by having things in one place. |
Governments are not measuring healthcare system adaptability well. |
|
[11] |
Practical performance evaluation |
Makes sure models are secure and reliable. |
Not many empirical investigations have taken place live [11]. |
|
[12] |
Compliance with GDPR/HIPAA |
Points out that regulation is an important part of the investment process |
Relatively little attention is paid to checking if regulations are applied correctly in API systems [12]. |
Table 2: Comparative analysis
(Source: Self-Created)
This table explains and highlights how each author focused, what they found and the most important research gaps in these studies. It states what API security in healthcare currently covers using JWT and OAuth, but points out that there are limited case studies and real-world examples.
The outcomes of the results align well with the study objectives. Because spending on healthcare is rising and the MedTech market is growing, it is urgent to solve current security problems regarding APIs in healthcare systems. JWT’s design and functioning, as well as those of OAuth, are demonstrated to speed up and improve access control in different systems [19]. NHS Digital and Babylon Health are excellent case studies that show API gateways can be used securely. Furthermore, such analysis reveals that these frameworks offer better performance and compliance in practice.
Using JWT and OAuth to secure API gateways is very important for modern healthcare systems. When controlling access to patient data with tokens, this information is less at risk of unauthorised use or hacking. Health services can use EHRs, telemedicine tools and third-party solutions together in compliance with GDPR and HIPAA [20]. In addition, these gateways make it simple for large healthcare networks to handle the creation, review and removal of identities and access rights across their systems, without burdening central servers [23]. As a result, activities are more efficient, data is protected, and patients trust the clinic more.
Setting up secure API gateways that rely on JWT and OAuth can be challenging. Lack of new interfaces in existing systems may stop or slow adoption. Dealing with the complexities involving keys, tokens and how to revoke them is very important and should be done carefully [21]. In addition, healthcare organisations have limitations with less money, not enough trained cybersecurity experts or unwillingness to change. There are very few real-time tests in healthcare systems, so it is hard to tell how effective and efficient each system is. Having said that, international standards such as HL7 and FHIR are unfortunately not used by all providers.
Healthcare institutions should focus on building secure API infrastructure and ensuring their staff are trained. It is important that organisations create rules for handling tokens and for their encryption mechanisms [22]. Regulators and government officials should sponsor trials in digital healthcare and draft security standards that match up with industry requirements and new advances in digital health systems.
With JWT and OAuth in API gateways, the study showed that healthcare systems benefit from stronger security, tighter access rules and following all necessary regulations. Studying NHS Digital and Babylon Health as real-life cases highlighted how data security helps and technical interoperability among different systems.
It is important for future work to research and evaluate these secure API gateways in real-life situations and by adopting HL7 and FHIR standards to ensure compatibility. Studies ought to analyse how systems perform when attacked and how users interact with different healthcare digital tools in different setups. Further, this can focus on using blockchain to make API transactions in medical imaging clearer and easier to track. In addition, testing gateway performance with a lot of imaging data and adding adaptive threat detection algorithms could help healthcare organisations resist new types of cyber threats.
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