The aim of this paper is to summarise common issues and challenges for health information systems (HIS) in Pacific Island Countries and Territories (PICTs) as identified by Pacific participants at two meetings held by the HIS Knowledge Hub in 2009 and provide suggestions for future action. The global agenda and drivers of HIS were discussed at both meetings to provide a clearer understanding of how Pacific Island countries are positioned within the larger international agenda. The two meetings provided the opportunity for participants to highlight suggestions for future action. Many of the solutions proposed highlighted the potential for regional solutions to progress the issue. This suggests an urgent need for national health authorities and regional partners to agree on strategies and programs to derive maximum benefit from regional HIS resources.