1. 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

2. © 2014, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. Overview Policymaking as a means of promoting public health Focus on state-level policy Role of DHMH

3. © 2014, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. What does DHMH do? Deputy Secretary Public Health Services Chief of Staff 24 Local Health Departments Policy Analyst Executive Associate

4. Office of Governmental Affairs4 The Progress of a Bill 1st Reading 2nd Reading (No paper copy; Floor amendments) 3 rd Reading (Floor amendments; Final Passage) First Chamber Referral to Committee (most issues resolved here) Second Chamber 1st Reading Referral to Committee (most issues resolved here) 2nd Reading (Floor amendments) 3rd Reading (Paper Copy; Full Floor- House of Origin; No Floor amendments) Consideration in Chamber which originated bill Conference Committee (only when necessary) To Governor

5. © 2014, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. Focus areas Medical ethics End of life care

6. © 2014, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. Advance care planning Purpose of advance directives Public health need and impact HB 1385

7. © 2014, Johns Hopkins University. All rights reserved. ©2016, Johns Hopkins University. All rights reserved. Lessons learned Policymaking is truly an iterative process State policy is actually a pivotal component of how DHMH promotes public health