Expanding Access to End of Life Care Planning:
The Creation of a Statewide Electronic Advance
Directive Registry in Maryland
Tehreem Rehman
Preceptor: Howard Haft, M.D.
Deputy Secretary for Public Health Services
Maryland Department of Health and Mental Hygiene
Overview
• Policymaking as a means of promoting public
health
• Focus on state-level policy
• Role of DHMH
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2014, Johns
JohnsHopkins
HopkinsUniversity.
University.All
Allrights
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reserved.
What does DHMH do?
Deputy Secretary
Public Health
Services
Chief of Staff
24 Local Health
Departments
Policy Analyst
© ©2016,
2014, Johns
JohnsHopkins
HopkinsUniversity.
University.All
Allrights
rightsreserved.
reserved.
Executive
Associate
The Progress of a Bill
First Chamber
1st Reading
Referral to Committee
(most issues resolved here)
2nd Reading
(No paper copy;
Floor amendments)
Second Chamber
1st Reading
Referral to Committee
(most issues resolved here)
Consideration in Chamber
which originated bill
Conference Committee
(only when necessary)
2nd Reading
(Floor amendments)
To Governor
3rd Reading
(Paper Copy;
Full Floor- House of Origin;
No Floor amendments)
3rd
Reading
(Floor amendments;
Final Passage)
Office of Governmental Affairs
4
Focus areas
• Medical ethics
• End of life care
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2014, Johns
JohnsHopkins
HopkinsUniversity.
University.All
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reserved.
Advance care planning
• Purpose of advance directives
• Public health need and impact
• HB 1385
© ©2016,
2014, Johns
JohnsHopkins
HopkinsUniversity.
University.All
Allrights
rightsreserved.
reserved.
Lessons learned
• Policymaking is truly an iterative process
• State policy is actually a pivotal component of
how DHMH promotes public health
© ©2016,
2014, Johns
JohnsHopkins
HopkinsUniversity.
University.All
Allrights
rightsreserved.
reserved.