The discussions from the NAQC’s eReferral Workgroup regarding the barriers and challenges of scaling up electronic referrals (eReferral) for quitlines. It highlights cost-related issues across various domains, including compliance and security (HIPAA, BAA), integration and migration (technical capacity, EMR variability), EMR vendor flexibility, and sustainability (education, investment, reporting). The report outlines specific cost challenges such as legal fees, consultant expenses, staff time, and software costs associated with each barrier. For each challenge area, the document also proposes potential solutions, ranging from establishing federal certifications and standards to fostering collaboration among vendors and creating resources for education and data management. The overarching goal is to identify and address these barriers to facilitate wider adoption and successful implementation of eReferral systems for tobacco cessation.