Overview Real World Evidence Brief comment on Machine Learning - - PDF document

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Overview Real World Evidence Brief comment on Machine Learning - - PDF document

10/26/2017 Data Systems in Ophthalmology Krishna Yeshwant kcy@google.com Overview Real World Evidence Brief comment on Machine Learning Lessons to date 1 10/26/2017 Opportunities - Real World Evidence RWE - Learning Health


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10/26/2017 1

Data Systems in Ophthalmology

Krishna Yeshwant kcy@google.com

Overview

  • Real World Evidence
  • Brief comment on Machine Learning
  • Lessons to date
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10/26/2017 2

Opportunities - Real World Evidence

2012 – IOM, Best Care at Lower Cost The Path to Continuously Learning Health Care in America

RWE - Learning Health System

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10/26/2017 3

2012 – IOM, Best Care at Lower Cost The Path to Continuously Learning Health Care in America

RWE - Learning Health System (now)

  • Highly structured data in Ophthalmology
  • Potential for pragmatic clinical trials
  • Clear use cases

–Large cohort analysis - e.g. Lucentis vs Avastin –Small cohort analysis - enable rare disease approvals

  • Potential for patient generated data

Potential for RWE in Ophthalmology

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2012 – IOM, Best Care at Lower Cost The Path to Continuously Learning Health Care in America

RWE - Learning Health System

2012 – IOM, Best Care at Lower Cost The Path to Continuously Learning Health Care in America

RWE - Learning Health System

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10/26/2017 5

2012 – IOM, Best Care at Lower Cost The Path to Continuously Learning Health Care in America

RWE - Learning Health System

  • Data and Output need to be transparent
  • Need for careful cohort selection
  • Pre-specified analysis plan
  • Culture / Incentives are critical

Regulatory Lessons from Oncology

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Opportunities - Machine Learning Traditional and “New” AI

The old way:

Write a computer program with explicit rules to follow

if email contains V!agrå then mark is-spam; if email contains … if email contains …

The new way:

Write a computer program to learn from examples

try to classify some emails; change self to reduce errors; repeat;

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Deep Learning Revolution

“cat”

Key Benefit

Learns features from raw, heterogeneous data No explicit feature engineering required

What’s New

layered network architecture, new training math, *scale*

Modern Reincarnation of Artificial Neural Networks

Collection of trainable mathematical units, organized in layers, that work together to solve complicated tasks

Adapt deep neural network to read fundus images

Conv Network - 26 layers No DR Mild DR Moderate DR Severe DR Proliferative DR Image Quality L/R eye Field of View

Jama 12/01/16

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  • “Intelligence is whatever machines haven't

done yet” - Larry Tessler (~1970)

  • When an AI application works it tends to get

characterized as an advance in another field.

AI Effect

Krishna Yeshwant

kcy@google.com