This case study details South Dakota’s initiative to establish eReferral capacity within the Avera McKennan Health System to enhance tobacco cessation referrals for priority populations including pregnant women, Medicaid recipients, and individuals with mental health conditions. Led by the Statewide Tobacco Cessation Coordinator, the project aimed to implement bi-directional eReferral and integrate ePrescription capabilities within Avera’s EHR system. Through targeted education and training in key departments, the project saw a 1.8% increase in eReferrals and developed valuable resources, despite challenges related to vendor communication, initial underutilization of the system, and varying EHR access across clinic sites. Key lessons learned highlighted the importance of strong IT collaboration, staff education, continuous evaluation, and incorporating provider feedback, particularly regarding the desire for eScript integration to streamline medication access for quitline participants.