group that will be used as the background to the research on this field introduced there. This work has the intention of clearly exposing some selected problems and solutions to real-time middleware design for general distributed applications and also for cyber-physical systems. The analyzed work starts with techiques for resource management that are focused at operating system level, the design of software engineering solutions for middleware, service oriented techniques, real-time reconfiguration, modeling of cyber-physical systems and real-time online verification, and hardware acceleration embedded into the middleware logic. Taking this as a solid baseline, the author will extend these works to suit the needs of medical systems.

Middleware definition {#sec:middefi}
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The term *“middleware”* has been used under different contexts. At first, it was described as a layer of software located between platforms and applications in distributed systems [@Bernstein1996MiddlewareAM]; it is widely defined as an software layer that connects two or more heterogeneous applications, systems, or structures [@Bishop03asurvey] which, by the end, provides an interface to transfer data and commands among the different stakeholders. In the medical domain, HL7 is one of the most important middleware technologies (referred to in sections \[sec:networking\] and \[sec:interoperability2\]).

Middleware is a reusable software layer that 