How can health care be redesigned to better meet the needs and preferences of the millions of Americans living with chronic conditions? This question is at the heart of James Ralston's research, compelling him to explore innovative designs of care that take advantage of new information technologies.

A general internist, Dr. Ralston joined Group Health Research Institute (GHRI) in 2003 to lead the Institute's health informatics research program. But his expertise and interests go far beyond informatics. While much of Dr. Ralston's work emphasizes information technologies as helpful components of care, they serve his true passion: that is, improving the health and health care of people who have common chronic conditions. This mission requires effectively evaluating new communication technologies that foster continuous care and a closer connection between patients and health care teams. In the past several years, Dr. Ralston has led and contributed to research showing that using the Internet to move care from the provider's office to the patient's home leads to promising outcomes.

In 2004, Dr. Ralston and colleagues at the University of Washington (UW) pilot-tested a Web-based diabetes management program: A case manager stayed in touch with participants by e-mail, encouraging them to review their online medical record, upload weekly blood sugar readings, and send secure messages as needed. Favorable results led to a randomized controlled trial that demonstrated better control of blood sugar levels in the study group. Another randomized trial was conducted with GHRI affiliate investigator Bev Green, MD, published in the Journal of the American Medical Association and in the news. It showed similar positive results for blood pressure management when Group Health patients used the Web to treat hypertension at home.

Dr. Ralston's commitment to finding effective redesigns of care spans all stages, from development to complete translation. With a team of GHRI and UW colleagues, he is helping evaluate Group Health's "access initiative"—a suite of innovations designed to make health care easier to get, in part by leveraging advances in information technology, such as secure member Web sites and electronic medical records (EMRs). Dr. Ralston also collaborates with the informatics department at Group Health, and he sits on the oversight committee that explores how doctors can best use it to help patients.

Dr. Ralston provides outpatient consultation through Group Health Permanente's Consultative Internal Medicine Group and is a volunteer medical advisor on the Steven's Pass ski patrol. He is also an affiliate associate professor in health services at the UW, where he serves on student PhD and MPH committees.

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Recent publications

Walker J, Leveille SG, Ngo L, Vodicka E, Darer JD, Dhanireddy S, Elmore JG, Feldman HJ, Lichtenfeld MJ, Oster N, Ralston JD, Ross SE, Delbanco T. Inviting patients to read their doctors' notes: patients and doctors look ahead: patient and physician surveys. Ann Intern Med. 2011;155(12):811-9. PubMed

Fishman PA, Anderson ML, Cook AJ, Ralston JD, Catz SL, Carlson J, Larson EB, Green BB. Accuracy of blood pressure measurements reported in an electronic medical record during routine primary care visits. J Clin Hypertens. 2011;13(11):821-8. PubMed

Jackson GL, Krein SL, Alverson DC, Darkins AW, Gunnar W, Harada ND, Helfrich CD, Houston TK, Klobucar TF, Nazi KM, Poropatich RK, Ralston JD, Bosworth HB. Defining core issues in utilizing information technology to improve access: evaluation and research agenda. J Gen Intern Med. 2011;26 Suppl 2:623-7. PubMed

Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH. Randomized trial of depression follow-up care by online messaging. J Gen Intern Med. 2011 Jul;26(7):698-704. Epub 2011 Mar 8. PubMed

Lyles CR, Harris LT, Le T, Flowers J, Tufano J, Britt D, Hoath J, Hirsch IB, Goldberg HI, Ralston JD. Qualitative evaluation of a mobile phone and web-based collaborative care intervention for patients with type 2 diabetes. Diabetes Technol Ther. 2011 May;13(5):563-9. Epub 2011 Mar 15. PubMed

Green BB, Anderson ML, Ralston JD, Catz S, Fishman PA, Cook AJ. Patient ability and willingness to participate in a web-based intervention to improve hypertension control. J Med Internet Res. 2011 Jan 20;13(1):e1. PubMed

McCarrier KP, Zimmerman FJ, Ralston JD, Martin DP. Associations between minimum wage policy and access to health care: evidence from the behavioral risk factor surveillance system, 1996-2007. Am J Public Health. 2011 Feb;101(2):359-67. Epub 2010 Dec 16. PubMed

Harris LT, Tufano J, Le T, Rees C, Lewis GA, Evert AB, Flowers J, Collins C, Hoath J, Hirsch IB, Goldberg HI, Ralston JD. Designing mobile support for glycemic control in patients with diabetes. J Biomed Inform. 2010;43(5 Suppl):S37-40. PubMed

Tufano JT, Ralston JD, Tarczy-Hornoch P, Reid RJ. Participatory (re)design of a sociotechnical healthcare delivery system: the Group Health patient-centered Medical Home. Stud Health Technol Inform. 2010;157:59-65. PubMed

Weppner WG, Ralston JD, Koepsell TD, Grothaus LC, Reid RJ, Jordan L, Larson EB. Use of a shared medical record with secure messaging by older patients with diabetes. Diabetes Care. 2010 Nov;33(11):2314-9. Epub 2010 Aug 25. PubMed

To view more publications, please see Dr. Ralston's CV.

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