Selayang Hospital is a pioneer in the implementation of Total Hospital Information System (THIS) in Malaysia. THIS model in Selayang Hospital integrates three critical components of hospital operations – clinical, imaging and administrative including finance. The deployment of THIS has significantly transformed some aspects of the traditional hospital work activities. The application of THIS however is a complex process. THIS has brought new issues and challenges in the context of hospital work environment. This paper describes the experience of Medical Record Department (MRD) of Selayang Hospital in dealing with several emerging issues and challenges resulting from the application of THIS. This paper particularly focuses on the experience of MRD in managing patient medical record in the early years of THIS application. It discusses issues, challenges and few innovative approaches implemented by MRD as solutions to facilitate the smooth integration and adaptation of THIS application in the work activities of managing patient medical record in Selayang Hospital.