Outpatient practice forms an integral part of medical care for patients needing care who are not admitted into the hospital, but receive the needed care and are discharged the same day which also largely includes primary care service. The growing demand for primary care physicians added by the complexity in managing outpatient practice effectively demands an optimized practice management system to coordinate care between different departments and provide high quality care on a timely fashion. The advent of health information technology has rapidly changed the way how outpatient practice has been done especially with the use of Electronic Health Records (EHR). Efficient use of such EHR has always been challenging, and several commercial software applications are available to facilitate outpatient practice management such as Microsoft's Amalga. However, commercial software does not aptly fit the needs of dynamically changing requirements in a hospital setting. Hence, the outpatient practice management department in Mayo Clinic which consistently ranks at the top in providing high quality care developed a custom outpatient practice application called Cohort Knowledge Solutions (CKS) to optimize the practice workflow and hence needs of the patients. This paper describes the design and development of CKS system, and its application in CTP/palliative care department and heart clinic which improved workload management, reduced follow up visits and readmission of patients using CKS.