The demographic change in Europe is leading to an increasingly aging population, increasing also the number of aged patients in health care. Subsequently, treatment of chronic diseases as well as integrated care approaches become progressively more important. We report preliminary evidence from four case studies on implementation and deployment of adaptive case management (ACM) systems for integrated care in context of chronic care related services and management. Our analysis focuses on what causes adaptations to the system’s initial model, and how the changes evolve over time. We identify several aspects of qualitative adaptations induced by clinical practice, including process parallelism, decision iteration, content fault tolerance, information presentation and combinative task variability. We also carry out a quantitative analysis of system changes. These changes comprise adaptations of different scope, which we categorize as in-structure, in-object and in-content changes. Our preliminary evidence and analysis indicate that ACM health information systems design must be able to accommodate particular types of changes triggered by the clinical context.