We develop a 5-year empirical investigation that is giving us broad and deep insights to characterise activity management in the palliative ward of an oncology hospital, and offer effective support for group decision-making and collaborative activity of caregivers. Following this observation period, we propose a software prototype based upon annotations in which dealing with patients’ state and evolution is a complex organisational task. We based our conception of an 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 addresses both management support and activity support in a single tool.