Twinning solution

Colon Capsule Endoscopy (CCE) for prevention and treatment of colorectal cancer

Twinning type

Full adoption

Main policy priority

Better data to promote research, disease prevention and personalised health and care


Odense University Hospital (South Denmark)


Digital Health and Care Institute, NHS Highland (UK)

Short description

The solution uses algorithms to review the videos of performed colonoscopies to examine the patients’ condition and ensure high-quality investigations. After a rigorous data collection process throughout clinical trials, the twinning sites are going to create a common database, ensuring comparability between the data collections.


Twinning activities

During the 12 months of the project, 17 online meetings took place. Internally, NHS Highland had regular discussions around data sharing between Scotland and Denmark. The nature of the data and legal infrastructure was the focus of these discussions. Mapping of the process to share data between the two countries was achieved although Brexit in the UK created some hurdles. A greater understanding of the governance to share data helped move the project forward and plan for future collaborations. This element of the twinning project was led by NHS Highland staff through the use of virtual meetings. In addition to the collaborative efforts and activities, the OUH team worked internally to prepare the data infrastructure for data sharing. This process included obtaining the necessary permissions for data storage. A significant amount of time was spent on preparing the AI part of the project and on aligning the data structure. Because of the barriers related to in part post-Brexit governance issues and in part COVID-19, the last part of the twinning process was focused more on clinical research that relates to the twinning outcomes. The OUH team took lead in writing up a research protocol on a number of joint studies that will take place in 2021.


Part of the focus of this twinning project was to initiate an international collaboration between institutions in both Denmark and Scotland. This outcome was met, and the collaboration is expected to continue after the end of the twinning period. The goal of the collaboration was to create a joint CCE infrastructure, which was partially completed. The twinning partners laid the ground work for the joint infrastructure by discussing data structure, aligning expectations and, specifically for NHS Highland, initiating processes to ensure data quality and create a centralised data collection.

Added value and benefits

The initial focus of the project was the sharing of images and data between the two countries. There is a particular interest to develop, refine and share algorithms developed for image reading, which will greatly benefit both parties. Given the challenges around this, alternative outputs and projects have been achieved. Commonality was a key benefit for both parties taking part in the twinning. The twinning partners aligned and agreed on common datasets for future use, allowing comparisons and future data analysis. This will form the basis for future collaboration between the two countries. Furthermore, areas of research were identified utilising our combined data and avoiding the need for complex data sharing. The partners started a research project to establish the accuracy of CCE for the location and size of polyps. This is novel research with strong clinical applicability and academic value.

Barriers and success factors

The workplan for the project was highly affected by the global pandemic, as most of the collaboration was planned around study visits and face-to-face meetings between the key staff members. In the end, there were no visits or face-to-face meetings during the project. Additionally, clinical staff resources were strained due to the pandemic. There was already a history of collaboration in both CCE and other areas between the Danish and Scottish partners, which was paramount to being able to carry out the collaboration on an entirely virtual basis throughout the previous year. Several of the people involved knew each other from before, which meant that there was an established relationship to build on and a great deal of goodwill and mutual understanding.


The twinning project allowed the twinning partners to agree on the basis and direction of future work. This will primarily include to sharing of patient CCE images for research purposes, which will require further ethical and legal review. A larger collaborative project could focus on this with an opportunity to adopt technological solutions for CCE image storage in the UK from Denmark.