The healthcare sector has undergone a profound transformation, owing to the influential role played by Internet of Medical Things (IoMT) technology. However, there are substantial concerns over these devices’ security and privacy-preserving mechanisms. The current literature on IoMT tends to focus on specific security features, rather than wholistic security concerning Confidentiality, Integrity, and Availability (CIA Triad), and the solutions are generally simulated and not tested in a real-world network. The proposed innovative solution is known as Secure-by-Design Real-Time IoMT Architecture for e-Health Population Monitoring (RTPM) and it can manage keys at both ends (IoMT device and IoMT server) to maintain high privacy standards and trust during the monitoring process and enable the IoMT devices to run safely and independently even if the server is compromised. However, the session keys are controlled by the trusted IoMT server to lighten the IoMT devices’ overheads, and the session keys are securely exchanged between the client system and the monitoring server. The proposed RTPM focuses on addressing the major security requirements for an IoMT system, i.e., the CIA Triad, and conducts device authentication, protects from Denial of Service (DoS) and Distributed Denial of Service (DDoS) attacks, and prevents non-repudiation attacks in real time. A self-healing solution during the network failure of live e-health monitoring is also incorporated in RTPM. The robustness and stress of the system are tested with different data types and by capturing live network traffic. The system’s performance is analysed using different security algorithms with different key sizes of RSA (1024 to 8192 bits), AES (128 to 256 bits), and SHA (256 bits) to support a resource-constraint-powered system when integrating with resource-demanding secure parameters and features. In the future, other security features like intrusion detection and prevention and the user’s experience and trust level of such a system will be tested.
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