are abstracted by the middleware.

Achieves interoperability by connecting medical devices, computational servers, applications and data storage solutions.

Patient data must be private, middleware can be the intermediate that ensures a certain level of privacy and especially when data is transferred into third party stakeholders.

Improves the portability of applications [@4519606], where an application can be executed under many plateforms.

Over the last years, middleware has proven successful to address the ever increasing complexity of distributed systems in a reusable way [@Issarny:2007:PFM:1253532.1254722], thus, middlewares are taking an important place in complex systems design like medical applications that controls medical devices that have a direct impact on patient safety or a medical system that controls drug injection in patient body.

Middleware is characterized by abstracting the low level details of the communication protocols and the hardware characteristics of devices to programmers [@sensorsice]. The distributed nature of medical applications requires the use of technologies such as middlewares that provides a bridge between layers or levels, the hardware layer can be connected to the application layer via a *middleware* and the protocols level can be connected to the security level via a *“middleware”*, so the use of the middleware depend on the context 