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Spoken dialog systems have been increasingly employed to provide ubiquitous access via telephone to information and services for the non-Internet-connected public. They have been successfully applied in the health care context; however, speech technology requires a considerable development investment. The advent of VoiceXML reduced the proliferation of incompatible dialog formalisms, at the expense of adding even more complexity. This paper introduces a novel architecture for dialogue representation and interpretation, AdaRTE, which allows developers to lay out dialog interactions through a high-level formalism, offering both declarative and procedural features. AdaRTE's aim is to provide a ground for deploying complex and adaptable dialogs whilst allowing experimentation and incremental adoption of innovative speech technologies. It enhances augmented transition networks with dynamic behavior, and drives multiple back-end realizers, including VoiceXML. It has been especially targeted to the health care context, because of the great scale and the need for reducing the barrier to a widespread adoption of dialog systems.