Introduction Colorectal Cancer (CRC) is the third most common malignancy. It is principally diagnosed by optical colonoscopy (OC). In many health systems demand for OC outstrips its supply, this was worsened by the COVID-19 pandemic. Colon Capsule Endoscopy (CCE) is an alternative lower gastrointestinal (GI) diagnostic test. The aim of this presentation is to chart the introduction and deployment, at scale, of this innovation in a publicly funded national health system. Methods CCE was introduced into NHS Scotland with qualitative, quantitative and health economic assessments. Its deployment was accelerated by the COVID-19 pandemic and supported by a national outcome registry and a central image library. All patient outcome data was collated prospectively into the globe’s largest repository of CCE demographic and imaging data. Results Over 6000 patient’s data have been collated in the registry. This has facilitated publication of test completion, sensitivity, specificity, and complication rates. The data has expediated continuous improvement and assisted in the exploration of Artificial Intelligent (AI) reading and reporting of CCE images. The ScotCap programme has contributed to the debate about thresholds for Faecal Immunochemistry Testing (FIT) and removal of diminutive polyps. It has also led to the initiation of the largest CCE diagnostic accuracy study, to date. Discussion CCE is a disruptive innovation in GI diagnostics. With new-entrant cheaper capsules, facilitated by AI reading and the ability for the test to be delivered at a patient’s home, CCE is likely to be utilised more in the future. Significant doubts about it’s utility remain amongst the clinical community but CCE could have a significant impact on CRC diagnosis.