I have an Epic system sending “ADT^A08^ADT_A01” as part of a message for Syndromic Surveillance (meaningful use). In my testing I demonstrated that if the message contains repeating OBX segments, the variant has repeating OBXs in the A01 definition and a single OBX in the A08 definition then the engine throws “segment encountered ‘OBX’ is out of order for message type ‘ADT_A08_ADT_A01’. Segment ignored.” errors for the repeating OBXs. If you make the A08 definition use a repeating OBX the errors go away.