This South Dakota case study on establishing eReferral capacity highlights several key lessons learned. Technology related to electronic medical records is constantly evolving, making close collaboration with IT crucial for successful implementation. Simply establishing an eReferral system is insufficient; staff education and training are essential for adoption and utilization. Even with a system-wide platform, access can vary across clinic sites, necessitating thorough evaluation and ongoing communication. Feedback from providers, particularly regarding the desire for eScript integration, proved invaluable in tailoring the system to user needs. Ultimately, the project’s success was attributed to established communication and trust with partners, a pre-existing eReferral process within the health system, and the incorporation of provider feedback.