This paper is a project report on the ongoing European project NEXES, running from 2008-2011. The project overall vision is improved quality of care for the chronically ill and elderly, through more Active follow-up of the patient in his/hers own home and improved collaboration processes between primary and secondary care services. A series of randomized clinical trials, to be carried out at three different sites, in Barcelona; Spain, Athens; Greece and Helse Midt-Norge;Norway are at the heart of the project, and deployment and evaluation of Information and Communication Technology (ICT) in the trials is a core objective. The project will contribute to standardised clinical pathways for chronically ill and produce requirements and guidelines on ICT deployment in such processes. The project has adopted the Business Process Modelling Notation (BPMN) standard as a tool for ddevelopment of the clinical pathways. This standard seems well suited in that it provides a common view for all care stakeholders, and aids in clarifying core issues regarding collaboration and information flow. Regarding the issue of ICT, the technology evaluation processes to be carried out in the project will constitute an important set requirements for future development of dedicated ICT solutions for chronic care processes.