We propose a software prototype based upon annotations management in palliative ward of an oncology hospital in which dealing with patients' state and evolutions is a complex organizational task. We develop a 5 years empirical investigation that is giving us broad and deep insights to characterize activity and offer an effective support for group decision making and collaborative activity of caregivers. We based our conception of annotation tool on the observations of the rich writing practices of medical professionals. We rely on the innovative strategy of intermediate management to introduce a new technology able to bridge heterogeneous valuable data flows that address both management support and activity support into a single tool.