In the European Standardization Committee (CEN), the technical committee responsible for the standardization activities in Medical Informatics (CEN TC 251), has agreed upon the directions of the scopes to follow in this field. They are described in the Directory of the European Standardization Requirements for Healthcare Informatics and Programme for the Development of Standards adopted on 02-28-1991 by CEN/TC 251 and approved by CEN/BT. Top-down objectives describe the common framework and items like terminology, security, more bottom up oriented items describe fields like medical imaging and multi-media. The draft standard is described; the general framework model and object oriented model; the interworking aspects, the relation to ISO standards, and the DICOM proposal. This paper also focuses on all the boundaries in the standardization work, which are also influencing the standardization process.