Threat-Adaptive Post-Quantum Authentication Pipeline for Telemedicine

Abstract

The increasing adoption of telemedicine has amplified concerns regarding the security of patient data, particularly in the context of remote authentication and the growing threat of advanced cyber and quantum-enabled attacks. Traditional telehealth security mechanisms rely on static authentication and cryptographic protections, which fail to adapt to changing risk conditions and provide limited resilience against credential compromise and future quantum threats. This paper proposes TAPQ-Health, a Threat-Adaptive Post-Quantum Authentication Pipeline that dynamically adjusts the strength of authentication and cryptographic hardness in real time based on contextual and behavioral risk. The proposed framework integrates four components a lightweight context-bound zero-knowledge proof authentication mechanism, a federated machine learning-based risk assessment model, threat-triggered escalation to lattice-based post-quantum cryptography with adaptive re-encryption, and decentralized, tamper-evident storage using IPFS. A fully implemented prototype was evaluated using 200 real telemedicine sessions and a large-scale analysis of 1.3 million authentication records. Experimental results demonstrate a mean end-to-end latency of 102.84 ms, 100 percent authentication success, and a 61 percent reduction in cryptographic overhead compared to static post-quantum configurations, while achieving 96 percent risk detection accuracy. These results indicate that threat-adaptive post-quantum authentication can significantly enhance telemedicine security without compromising usability or scalability.