the   clinical laboratory 
  is arguably the frontrunner in applying 
 scientific discoveries and technical 
 innovations 
 to patient care . 
 for example
,   there are not only far more tests readily available 
 now compared to just twenty years ago but also the tests themselves have 
 increased sensitivity and specificity ( e.g. , hs - crp , ferritin ) . it has been 
 estimated that about 65% of medical decisions are based on laboratory tests .
paradoxically , the clinical laboratory success has placed it under even 
 greater pressure   to produce more and better test results , with shorter 
 turnaround times and at lower costs .
as clinical laboratories have evolved , 
 they have relied heavily on automation . by moving from manual assays of single 
 analytes to random access , multichannel , automated instruments , and more tests 

can be done , more frequently , with fewer people . as noted in recent 
 publications , by combining several of these instruments into a novel single 
 platform for the clinical chemistry   and 
 for the immunochemistry laboratory
however , there has been little integration of traditional clinical 
 chemistry ( ise , spectrophotometry , homogeneous immunoassay ) and heterogeneous 
 immunoassay . from an analytical and technology perspective
but , from a medical perspective , of course , 
 the separation is entirely artificial . for the patient in the emergency room
, 
 the physician needs to know the troponin and the potassium . for the oncology 
 patient , the physician needs to know the cea as well as the calcium .
does it 
 make sense to draw two tubes of blood to insure quick turnaround time by 
 running the sample on two analysers simultaneously ? or , if just one tube is 
 drawn , is it the only solution to insure quick turnaround time by asking a 
 technologist to make sure that , as soon as the tube is finished on the 
 chemistry analyser , it gets placed on the immunoassay analyser to be analysed 
 there ? with either scenario ,
there are inherent inefficiencies , as compared to 
 running a single tube on a single system for all the requested tests . 

modular analytics swa ( in usa : integrated modular analytics , i m a ) , 
 thereafter modular system , represents the integration of comprehensive systems 
 for traditional clinical chemistry and for heterogeneous immunoassays into a 
 single system for essentially all chemistry analytes . here
we present the results of our studies at 6 laboratories with a 
 single system processing a selection of 30 to 50 different tests for clinical 
 chemistry , specific proteins , therapeutic drugs , and immunochemistry 
 determination . 

evaluate the functionality and 
 practicability of the analyser;determine whether improved efficiency 
 would be realized by integrating clinical chemistry with heterogeneous 
 immunoassay testing;test 
 for possible effects on the quality of results ( reproducibility , carryover ) due 
 to consolidation . 

in addition , we predicted that there would be a reduction of sample 
 splitting , the elimination of multiple user interfaces , and a reduction of 
 hands - on labour .
evaluate the functionality and 
 practicability of the analyser ; determine whether improved efficiency 
 would be realized by integrating clinical chemistry with heterogeneous 
 immunoassay testing ; test 
 for possible effects on the quality of results ( reproducibility , carryover ) due 
 to consolidation .
experiments were performed on modular system in five laboratories over a 
 period of five months . at a sixth site ,
modular   analytics serum work area combines previously evaluated 
 modular systems for clinical chemistry and immunochemistry : modular 
 analytics d , p and modular analytics e [ 2 , 3 ] .
the modular system consists of a control unit , a core unit with a bidirectional 
 multitrack rack transportation system , and four kinds of analytical modules  an ise module for 
 the electrolytes na , k , and cl with a maximum throughput of 900 tests / hour , a 
 p800 module with a capacity of 44 spectrophotometric tests on board and a 
 maximum throughput of 800 tests / hour , a d2400 module with 16 spectrophotometric 
 tests and a maximum throughput of 2400 tests / hour , and an e170 module using the 
 electrochemiluminescence technology with a capacity of 25 immunochemistry 
 reagents on board and a throughput of up to 170 tests / hour .
the configurations 
 of modular system are versatile and allow customised module combinations for 
 various laboratory workload patterns . of the several available hardware 
 combinations , three different combinations of the clinical chemistry modules d 
 and p and the immunochemistry module e
were evaluated at the six sites ( 3 pe , 2 ppe , and 1 dpe ) ; all systems included an ise 
 module .
the instruments used in the different laboratories for comparison with 
 modular system during the workflow study were modular analytics p , pp , e , elecsys 2010 ( elecsys 
 is a trademark of a member of the roche group ) , hitachi 747 and 917 , all from roche 
 diagnostics ( mannheim , germany ) , the bna ii protein analyser from dade behring 
 ( liederbach , germany ) , the advia centaur and acs : 180 from bayer ( tarrytown , ny , usa ) and the axsym from abbott laboratories , ( abbott park , illinois , 
 usa ) .
the methods selected for the workflow studies covering approximately 80 
 analytes with 30 to 50 applications per laboratory are summarised in table 1 . 
 for the imprecision runs and functionality testing ,
the calibration of the 
 tests was done according to the requirements set by the manufacturer using the 
 calibration materials from roche diagnostics .
the daily quality control was 
 performed with control sera also provided by the manufacturer .
depending on the analyte , either control material or human specimen 
 pools were used for the imprecision and routine simulation 
 imprecision experiments .
samples for the workflow experiments 
 included serum , heparinized plasma and urine from the daily routine .
the performance evaluation was supported by caev , a program for computer 
 aided evaluation . 

this program allows the definition of experiments , the sample and test 
 requests , on - line / off - line data transmission , and the immediate data validation 
 by the evaluators .
  two control materials ( serum , urine ) with 
 different concentrations of the analyte ( or , for some analytes , a human 
 specimen pool at the diagnostic decision level ) were used .
experiments for routine simulation are 
 designed for functionality testing of an analytical system in the clinical 
 laboratory .
the protocol   has 
 proven to be a useful tool during various analyser evaluations .
this particular experiment tests for potential systematic or random 
 errors by comparing the imprecision of the reference results ( standard batch , n = 15 ) with results from samples run in a pattern simulating routine sampling ( randomized 
 sample requests , n > 10 ) .
the randomized sample requests were simulated in 
 caev   according to each laboratory 's routine 
 sampling pattern .
the number of requests varied with module combination , but was aimed at keeping 
 the analyser in operation for at least four hours .
the second and third of the 
 three experiments processed at each site included provocation incidents like 
 reagent or sample shortage , barcode read errors , and various reruns .  
potential sample related carryover was investigated 
 using a slightly modified version of the broughton protocol . only analytes with a very high physiological 
 concentration range were tested .
ideally , the ratio of the concentrations of 
 the high and low samples should be , depending on the analyte , 10 to 
  10 .
three aliquots of a high concentration sample ( h1 , h2 , h3 ) were 
 followed by measurements of five aliquots of a low concentration sample ( l1  l5 ) on each module .
the sequence h1 h2 h3 l1 l2 l3 l4 l5 was 
 repeated five times .
each sample was measured on the ise module first , then on the d and/or p 
 module , and finally on the e170 module , thereby insuring that reusable pipette 
 probes were introduced multiple times prior to sampling on the e170 module , 
 where disposable ( nonreusable ) pipette tips are used . if a carry - over effect 
 from the ise and d / p module sample probes
exists , the l1 will be the most influenced , and the l5 will be the least influenced aliquot when 
 measured on e - module .
the carry - over effects were compared with the imprecision 
 of the low concentration samples and the diagnostic relevance of the respective 
 e - module assays .
potential sample carryover of the following analytes was 
 tested : afp , cea , ferritin , anti - hav , hbsag , hcg +  , and t - psa .
the participating sites performed this study to 
 investigate whether or not modular system met their routine laboratory specific 
 needs , especially for improved efficiency .
as shown in table 2 , module 
 combination , analyte assignment , tests per sample , numbers of samples , samples 
 per module , and tests per module , were very different at each laboratory .
three 
 methods were used to capture the test requests on samples so that the same 
 testing could be repeated on modular system .
test requests were either 
 downloaded from the laboratory 's lis to caev , captured directly by caev from 
 several analysers during routine operation or caev provided a  characteristic  

request list by simulation based on typical test frequencies and profiles of 
 the laboratory . in all cases , the same sample set
, usually a predefined 
 substantial portion of a day 's workload was processed on modular system .
samples were loaded on modular system chronologically as they appeared 
 in the lab to mimic the laboratory 's routine pattern of receiving samples .
all 
 relevant time steps and workload related activities like sample and reagent 
 handling , instrument preparation , loading and reloading of sample racks , and 
 technologist time ( both hands - on and walk - away ) were measured .  
practicability of the system was assessed throughout 
 the study . a questionnaire  a supplement to 
 the general questionnaire , 
 which was previously used for the assessment of the single modules  was designed 
 especially for a consolidated sample working area .
this allowed for a standardized 
 grading with the main focus on aspects of clinical chemistry and immunochemistry 
 consolidation and new software features .
the protocol included expected performance criteria 
 which were agreed upon at the evaluators ' first meeting .
the criteria for 
 imprecision were based on state - of - the - art performance , routine requirements of 
 the laboratories , and statistical error propagation .
across all experiments , 236000 results from 32400 samples were generated 
 using 93 methods .
the within - run imprecision met the expected performance criteria at 
 virtually all sites . 

typical within - run cvs for the enzyme and 
 substrate analytes were 1 to 2% , for the ion selective electrode ( ise ) methods 
 0.5% , for the specific proteins and drug analytes 1 to 3% , for the urine 
 chemistry methods 1 to 2% , and for the heterogeneous immunoassays ( with the 
 indication : thyroid , cardiac , anaemia , tumour markers and fertility ) 1 to 3% 
 ( table 1 ) .
the six laboratories performed 44668 determinations during the random 
 part of the routine simulation covering 87 analytes in 733 series .
cvs obtained 
 from the precision in a simulated routine run experiment for the various 
 assay groups ( ises , enzymes / substrates , urine analytes , proteins / tdms , and 
 heterogeneous immunoassays ) were summarized in distribution diagrams for the 
 reference ( batch part ) and random part ( see figure 2 ) .
out of all 733 series , 
 13 ( 1.8% ) showed higher cvs than the expected limit in the random part ( 9 in 
 the enzyme / substrate group , 2 in the urine and the immunoassay groups ) .
seven 
 of these cvs were only moderately increased ( 1 to 2% higher than the limit ) .
of 
 the remaining 6 series ( 5.3 to 22.8% cv ) , the highest cv was caused by an 
 unexplainable , nonreproducible outlier with a very low result in one series of 
 the albumin in urine test . with
the higher cvs were observed in only one of the three simulated routine 
 series per laboratory ( with tests like lipase , uric acid , albumin in urine and 
 ca125 ) and there was no association with any malfunction of the instrument or 
 reagent . a software issue associated with the e - module masking / unmasking during 
 a provocation
was also identified during these experiments ( shift of the 
 results with the ft3 assay ) .
table 3 summarizes the carry - over effects seen when the high priority settings were intentionally turned off for a group of tests that were 
 considered high risk for sample carryover . only results from laboratories with 
 the highest concentration ratio ( high / low ) are included in the table . for the 7 
 assays for which we expected to see sample - related carryover because of the 
 wide dynamic range of the analytes , our testing indicated potentially 
 clinically relevant problems with 5 ( afp , cea , hbsag , hcg +  , and t - psa ) . by 
 utilizing the 
high priority test  option , samples with requests for these 
 assays , which also had requests for ise , d , and/or p module tests , were 
 automatically processed at the e - module first , eliminating the possibility for 
 carryover to occur for these samples and tests . in the other two (
ferritin and 
 anti_hav ) , neither criterion for carryover was met ( more than 10% of the 
 ( lower ) medical decision level , or exceeding the 2 sd value ) . according to 
 investigations of the manufacturer
, two additional carry - over sensitive 
 infectious disease assays were identified : anti - hbs and anti - hbc . the module combinations ( pe , ppe , dpe ) and test 
 menu configurations used at the different laboratories
the samples were placed on the system in a 
 sequence mimicking the original arrival pattern in the laboratory , rather than 
 continuously , to test the system 's potential sample loading capacity .
the 
 resulting cumulative throughput was up to 800 results / hour using pe 
 module combinations and up to 1580 results / hour for ppe module 
 combinations .
a throughput of approximately 2160 results / hour was yielded on 
 the dpe module combination in laboratory 6 . in most of the 
 laboratories ,
the number of samples processed was not enough to reach the 
 system 's maximum throughput capacity .
in addition to throughput , we looked carefully at sample processing time 
 ( spt ) , the time between sample registration ( barcode reading on the instrument ) 
 and the time the last result for that sample is produced .
note that spt differs 
 from sample turnaround time ( tat ) , a commonly used term to describe the time 
 period from when the samples arrive in the laboratory and the availability of 
 the last result .
the following mean sample processing 
 times were found for the different sample groups in five laboratories : 

 1318 minutes for samples with general chemistry 
 requests only 
 ( ise + p or ise + p1 + p2 ) , 
 2228 minutes for 
 samples with immunoassay requests only ( e ) , 
 2938 minutes for 
 samples with combined requests 
 ( ise + p + e or ise + p1 + p2 + e ) . 

the mean spts obtained with a dpecombination were comparable : 
 16 minutes for ise + d + p , 26 minutes for e , and 27 minutes for ise + d + p + e. 
 1318 minutes for samples with general chemistry 
 requests only 
 ( ise + p or ise + p1 + p2 ) , 
 2228 minutes for 
 samples with immunoassay requests only ( e ) , 
 2938 minutes for 
 samples with combined requests 
 ( ise + p + e or ise + p1 + p2 + e ) .
we compared spt of modular ppe with the current six dedicated 
 routine analysers for a predetermined time period , representing approximately 
 40% of a day 's workload in laboratory 5 .
figure 3 shows that the time to 
 results for samples with clinical chemistry requests on modular system is 
 comparable with that of the dedicated routine analysers ( mean time 15 minutes , 
 80th percentile 20 minutes , maximum 38 
 minutes )
. samples with combined requests for both 
 clinical chemistry and immunochemistry were 
 processed faster ( mean time 34 minutes , 80th percentile 40 minutes , maximum 1 hour ) 
 than on the dedicated analysers ( mean time 46 minutes , 80th percentile 58 minutes , maximum 1.8 hours ) .
depending on test , module and number of 
 racks waiting in the rerun buffer , rerun results are reported 1035 minutes after 
 availability of first results .
an example of typical processing times to first 
 results and to final results ( including rerun samples ) is shown in figure 4 .
modular swa 
  supports  reflex 
 testing ,  if the laboratory information system ( lis ) offers this functionality . 

frequently practiced for certain indication fields , this feature allows the 
 automatic request of a further analyte , if a predefined concentration or 
 concentration range of the originally requested analyte is exceeded .
examples 
 are as follows : if tsh < 0.27 or > 4.2 miu / l , ft4 is determined in 
 addition , if psa > 4.0 g / l , free psa is also measured and so on . even 
 though it may no longer be as clinically relevant , reflex testing functionality 
 was assessed using a combination of p - and e - requests : ck  ck - mb(enzymatic ) + tnt .
the spt for 
 such a sample with two additional reflex tests was increased by 30 to 55 
 minutes ( figure 5 ) .
does the   sample carry - over setting , which tags the assay in 
 question automatically as   high priority by the system , influence the 
 spt ?
we compared samples having combined requests ( on p- and e - module ) with and 
 without   high priority assays . with   auto rerun off , there was no 
 result delay .
the processing times were increased by 1015 minutes with   auto 
 rerun   activated , where processing on p module was delayed until final e - module 
 results were available .
maintenance and troubleshooting are activities which may also 
 considerably influence the daily workflow . for a modular system , the question 
 arises whether the entire system or only the affected module is blocked in 
 order to remedy a problem after , for example , a sampling stop alarm . 

the different time steps for two such alarms were monitored on a ppe 
 combination at one site . for a provoked tip / vessel pickup - error on the 
 e - module ,
the elapsed time from getting the alarm , allowing the module to 
 finish the tests in process , taking the module down , then fixing the problem , 
 and getting the module back into operation was a total of 35 minutes ; for a 
 provoked abnormal cap mechanism movement 22 minutes .
while the e - module 
 was unavailable , the ise and p - modules continued to process samples , and 
 samples requiring e - module tests were stored in the rerun buffer to be run 
 automatically when the e - module came back online .
an important aspect of instrument consolidation on a single platform is 
 reduction in personnel hands - on time . in laboratory 5 , we compared hands - on 
 time associated with modular system with that of the 6 existing dedicated 
 analysers . as shown in figure 6 , the operators saved about 10 hours based on 
 the sample workload ; the main contribution was sample handling time .
modular 
 system was operated by 1 technologist while the 6 dedicated analysers required 3 
 persons .
one of the participating laboratories ( laboratory 1 ) simulated a 
 workflow using modular system as a dedicated immunoassay analyser .
tests 
 included 24 homogeneous tests ( 10 specific proteins , 6 therapeutic drug tests , 
 and 8 drugs of abuse tests ) on p - module and 18 heterogeneous assays ( thyroid , 
 cardiac , anaemia , and tumour markers ) on the e - module , with samples loaded in a 
 simulated routine - type pattern .
the average sample processing times for the 
 various request patterns were comparable with those mentioned previously 
 ( < 35 minutes ) . with the aid of a questionnaire ,
the practicability of modular system 
 was graded as equally good ( 23% of all scores ) or even better ( 68% ) compared to 
 the evaluators ' currently used routine analysers .
it was 
 the first time that there was an opportunity during an evaluation to combine 
 various laboratory segments with an extensive menu for general chemistry , 
 specific proteins , drugs , and immunochemistry on one platform . since analytical performance
was previously verified for the single 
 modular systems [ 2 , 3 ] , this study did not include extensive analytical performance data . 

however , one or two imprecision runs were processed for representative 
 tests from each analyte group to assure that the system was performing correctly . 

typical within - run cvs of 1 to 3% across the menu of nearly 90 tests were all 
 within the expected performance and can be rated as excellent .
we can emphasize 
 here that the heterogeneous immunoassays performed with the electrochemiluminescence 
 technology showed reproducibility similar to the general chemistry tests and 
 well within clinical demands ( see table 1 ) 
 [ 1012 ] .
the overall low cvs for all analyte groups in the simulated routine 
 imprecision runs proved that general chemistry and immunochemistry worked very 
 well together , and , that even under simulated stress routine conditions , 
 there was no indication of systematic or random errors .
the 6 high cvs of the 
 routine simulation experiment occurred in only one of 3 runs per laboratory , 
 and there was no indication that the deviant results were reproducible .
the 
 routine simulation precision experiments demonstrated good performance and full 
 functionality of the instrument . because of the sensitivity of the experimental 
 design , it was possible to identify one severe instrument problem associated 
 with the e - module masking / unmasking feature during provocation of the analyser . 

the error was corrected with a software upgrade and the correct implementation 
 was confirmed with further routine simulation runs at all sites . throughout all 
 other routine environment testing ,
modular system runs with new user software , combining and unifying the 
 functionality and features of the single modules and optimizing the processing 
 of clinical chemistry and immunochemistry requests . for example , sample carryover 
 to some sensitive immunoassays can not occur due to intelligent sample processing 
 whereby samples with requests for carryover sensitive assays , referred to as high 
 priority tests , are processed at the immunology module ( e ) first .
high 
 priority tests are user - definable and do not delay processing of other 
 samples , even samples in the same sample rack . as mentioned in the results section , 
 processing samples with high priority requests with
 auto - rerun  
 activated took 15 minutes longer in comparison to the usual samples . this 
 however , reduced potential risks and eliminated any manual operator 
 intervention .
if there are only very few specimens with concentrations above 
 the upper measuring range limit of the high priority tests , the 
 laboratory manager can decide to deactivate auto - rerun without any high 
 risk of quality loss but with acceleration of result availability .
workflow depends strongly on the laboratory environment , the sample 
 loading pattern , and on the modular configuration .
our studies show that 
 modular system offers the flexibility to fit and meet the requirements of the 
 individual laboratory .
the variations in throughput at the different sites can 
 be explained by the lab - specific workloads and sample loading patterns .
the processing times for the sample groups with general or 
 immunochemistry requests were similar to those known from the respective stand - alone modules , thus showing that there was no relevant increase when combining 
 photometric / ise and e - modules . in other words , the immunochemistry module did 
 not slow down the clinical chemistry modules .
an average processing time of 
 approximately 35 minutes for the combined group was rated as being very 
 acceptable , bearing in mind that those samples were either measured 
 sequentially on different routine instruments or required additional hands - on 
 times for splitting / aliquoting in the routine with the current routine 
 instrumentation .
in fact , when these additional times were included , as done in 
 one laboratory , the mean sample tat decreased by three hours ( from 3.5 to 0.5 
 hours ) using modular system .
one laboratory used the pe combination for simulating a 
 dedicated immunoassay analyser covering various laboratory segments . in this 
 hospital
there is a separate sample collection and order process for certain 
 analytes , which are presently performed on a variety of single analysers . 

the current dedicated analysers 
 for protein determinations , for drug monitoring or tumour marker measurements 
 could be replaced by a consolidated workstation , so that only one operator 
 would be needed to perform these various immunoassays .
the laboratory 
 management assessed a 30 to 50% reduction of manpower for this work on modular 
 system . during the daily routine ,
a certain percentage of assays ( usually < 5% ) need a repetition of the analysis , because the measuring range or a defined 
 repeat limit based on laboratory policy is exceeded .
the portion of repeat 
 measurements due to analytical range limitations on modular system is usually 
 smaller than 0.5% . 

modular system offers a user selectable automatic rerun feature , 
 which can be activated or deactivated for each test .
the advantages of automatic rerun  no need for 
 sample tracking , retrieval , elimination of manual sample predilution , and no 
 manual reloading  not only increased 
 safety of results by minimizing possible human error , but also reduced 
 processing and hands - on times .
it is not necessary to wait for the result validation and the 
 confirmation from the ward to perform the additional   reflex assay .
this 
 is especially important for outpatients since this procedure could avoid a 
 second hospital visit .
even if samples are held for further tests , reflex 
 testing is better than the alternatives  measuring for all 
 tests at the start or manual intervention to locate and transport the samples . 
 when including the benefits of automatic rerun analysis and reflex testing , 
 results were available within 30 to 70 minutes .
since the time of this evaluation , the use of modular system has 
 confirmed this data during a long period of routine work . when comparing the 
 hands - on times captured at the different sites over one to two days , modular 
 system yielded a clear advantage .
monitoring over an extended period would be 
 necessary to obtain more extensive data , but this exceeded the scope of the 
 study . nevertheless , it is obvious that there is a potential of saving 
 personnel capacities since fewer instruments need fewer persons for operation . 

modular system requires a skilled operator similar in qualification to that of 
 the existing analysers compared in this study .
however , this person must also 
 be able to cope with the validation of a large amount of data produced within a 
 short time or have autoverification available .
the practicability of modular system met or exceeded the requirements of 
 all participating laboratories for 91% of all attributes rated .
an opportunity 
 for improvement was seen in the time required to prepare the analyser for routine 
 use even though this was one half to three quarters of the time required for 
 the dedicated routine analysers .
apart from the qc measurements which were 
 processed directly before routine sampling start , the flexibility of modular 
 system with background maintenance features allows other tasks to be performed 
 at any suitable time throughout the shift .
completion of initial qc 
 measurements for the extended menu processed at the different sites took an 
 average 30 minutes .
the main advantage mentioned by the evaluators was the consolidation 
 effect resulting in a simplified workflow with a reduction of instruments , 
 reduced overall processing time , reduced hands - on time , and increased 
 efficiency without increasing staffing , yet maintaining or even improving 
 quality .
our experience with the modular analytics swa indicates that both 
 functionally and practically the analyser is a favourable addition to the 
 clinical laboratory .
each of the various module configurations included in this 
 study is easily and efficiently managed routine and nonroutine tasks in the 
 simulated routine scenarios .
overall , samples with combined requests running in 
 routine workloads , from a menu of about 50 assays , were processed in 
 approximately 35 minutes ; 30 to 70 minutes including reruns and reflex testing . 

we saw no negative effects in the quality or timely reporting of test results 
 when combining general clinical chemistry with heterogeneous immunochemistry 
 assays on the same analyser .
in fact , we found that efficiency was improved , and , 
 in some cases substantially decreasing sample turn - around time , operator 
 hands - on time , and personnel , while maintaining or improving the quality of 
 laboratory processes .
 modular analytics serum work area ( in usa 
	 integrated modular analytics , modular analytics is a trademark of a member of the roche group )   represents a further approach to automation in the laboratory medicine . 
 this instrument combines previously introduced modular systems for the clinical chemistry and immunochemistry laboratory and allows customised combinations for various laboratory workloads . 
 
 functionality , practicability , and workflow behaviour of modular analytics 
 serum work area were evaluated in an international multicenter study at six laboratories . across 
 all experiments , 
 236000 results from 32400 samples were generated using 93 methods . 
 simulated routine testing which included provocation incidents and anomalous situations demonstrated good performance and full functionality . 
 heterogeneous immunoassays , performed on the e - module with the electrochemiluminescence technology , showed reproducibility at the same level of the general chemistry tests , which was well within the clinical demands . 
 sample 
 carryover can not occur due to intelligent sample processing . 
 workflow experiments 
 for the various module combinations , with menus of about 50 assays , yielded mean sample processing times   of 
 < 38 minutes for combined clinical chemistry and immunochemistry requests ; < 50 minutes including automatically repeated samples . 
 modular 
 analytics serum work area offered simplified workflow by combining various laboratory segments . 
 it increased efficiency while maintaining or even improving quality of laboratory processes . 
1. INTRODUCTION
2. MATERIALS AND METHODS
3. EVALUATION PROTOCOL
4. RESULTS
5. DISCUSSION
6. CONCLUSION