A critical issue in healthcare informatics is to facilitate the integration and interoperability of applications. This goal can be achieved through an open architecture based on a middleware independent from specific applications; useful for working with existing systems, as well as for the integration of new systems. Several standard organizations are making efforts toward this target. This work is based on the EN 12967-1,2,3, developed by CEN, that follows the ODP (Open Distributed Processing) methodology, providing a specification of distributed systems based on the definition of five viewpoints. However, only the three upper viewpoints are used to produce EN 12967, the two lower viewpoints should be considered in the implementation context. We are using Semantic Grid for lower views and Semantic Web and Web Services for the definition of the upper views. We analyze benefits of using these methods and technologies and expose methodology for the development of this semantic healthcare middleware observing European Standards.