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In other developing countries such as in the South East Asia region, it has been suggested that PACS has a slow diffusion rate. 23 attributed the slow growth in this region to factors such as high cost, under-developed health care facilities and a lack of ability to deliver the high-technology infrastructure required. Nevertheless, due to the proactive role of the government and increasing demand in the medical tourism sector such as in the case of Malaysia, Thailand and the Philippines, Frost & Sullivan anticipated a positive growth for the South East Asia market in 2009. As for third world countries, the status of PACS diffusion is unknown. However, there have been several on-going projects that capitalize on the innovative features of PACS to provide healthcare radiology assistance under e-health and telehealth initiatives to help various third world countries, including some from Africa. A large-scale PACS installation will include RIS and HIS applications. Whilst PACS enables the efficient storage, processing, management and retrieval of image data, RIS on the other hand, permits online diagnostic reporting, patient scheduling, tracking of patient images and billing. For PACS and RIS to effectively support radiology in a hospital, important data such as patient registration, admission and discharge needs to be obtained from the HIS database. Some technical details pertaining to PACS/RIS/HIS integration can be read. A study that surveyed more than 275 sites that had implemented PACS reported that over 75% of the sites had an interface with RIS, and about 48% had an interface with HIS. The growth of the RIS market is largely pushed by the expansion of the filmless work environment. RIS was argued to have low usage in a film-based radiology work practice. Initiatives such as Integrating the Health Care Enterprise (IHE) taskforce that is responsible for establishing common integration standards.

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