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Data mining has been recently experiencing a boom of interest from researchers and software producers. In medicine, however, its applications are still rather rare. In this paper, we argue that this is primarily due to the requirements of reproducibility of results and diversity of available data mining tools, both of which are crucially important for medical research. We propose to tackle the diversity requirement by means of distributed object technologies. The results presented here rely on our experience with medical data mining using the method GUHA and with further developing that method.

The development of healthcare systems in accordance to the "Shared Care" paradigm results in co-operative health information systems across the boundaries of organisational, technological, and policy domains. Increasingly, these distributed and heterogeneous systems are based on middleware approaches, such as CORBA. Regarding the sensitivity of personal and medical data, such open, distributed, and heterogeneous health information systems demand a high level of data protection and data security, both with respect to patient information and with respect to users. The security concepts and measures available and additionally needed in health information systems based on CORBA architecture are described in this paper. The proposed security solution is also open to other middleware approaches, such as DHE or HL7.

To meet the challenges for efficient and high-level quality, health care systems must implement the "Shared Care" paradigm of distributed co-operating systems. To this end, both the newly developed and legacy applications must be fully integrated into the care process. These requirements can be fulfilled by information systems based on middleware concepts. In the paper, the middleware approaches HL7, DHE, and CORBA are described. The relevance of those approaches to the healthcare domain is documented. The description presented here is complemented through two other papers in this volume, concentrating on the evaluation of the approaches, and on their security threats and solutions.

Increasingly, distributed, interoperable healthcare information systems, which meet the shared care paradigm, work across the boundaries of policy, organisational, and technological domains and are based on middleware concepts. Especially in healthcare with its sensitive personal and medical data, such systems require advanced data security measures. In the paper, a common object-oriented security model for middleware systems and advertisements for implementation are proposed, corresponding the security requirement of both the user and the application environment.

Regarding the need of change of both healthcare systems' structure and supporting information systems' architecture to the "Shared Care" paradigm, appropriate health information systems have to be distributed and interoperable, and will usually be based on middleware concepts. Structure and function of information systems meeting such requirements have been analysed in general. To describe, evaluate and combine distributed systems, a generic component model has been used. As a result, CORBA, DHE, and HL7 have been assessed systematically. A way to a common and harmonised middleware approach has been proposed.