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Density of medical clinics, ease of access to doctors, the age pyramid of the population - these are differentiating factors among patients living in urban or rural areas which may affect the probability to survive certain diseases and attacks dramatically. The German Fontane project, a collaboration of medical experts, IT researchers and companies, focuses on remote monitoring and aftercare facilities for stroke patients and patients with heart diseases in rural Brandenburg. Within this paper, we discuss central requirements on the object-oriented self-adaptive middleware being developed for Fontane. We describe the overall system requirements, and show our approach for combining real-time data streaming interaction with classical object-oriented remote calls in one distributed middleware stack. The resulting system will form the foundation for transmission of real-time data from devices at patients' home to the remote tele-medicine monitoring center.