The original FOTO data collection and benchmark reporting service was initiated through a grant from six national rehabilitation companies, Caremark Inc., Continental Medical Systems, HealthSouth Inc., Med Rehab Inc., NovaCare Inc. Outpatient Division, and Rehability Inc. The companies engaged Alan Jette PhD, PT, and the New England Research Institute, Boston Massachusetts, to select the outcome measures, design the data collection process, and manage the data base.

In 1994, full rights and ownership were transferred to the current proprietors, Al Amato, PT, MBA and Ben Johnston, PT. Both were involved in the development of the process while holding employment positions with separate contributing rehabilitation companies. FOTO is now entirely independent from ownership by providers of rehabilitation services. In this early development phase the SF-36, Oswestry, Lysholm, and the Neck Disability Index functional scales were used on all low back, knee, and neck patients respectively in selected clinics from the founding companies. Research was conducted on over 10,000 patient episodes of care. The results of the research included:

• Validation of the physical function scale in the SF-36 as responsive to change in low back, knee and neck impairments.
• Development of an Outcome Index to describe the amount of change in health status during an episode of care in an outpatient rehabilitation facility.
• Development of a Value Index as the amount of change in health status per dollar spent.
• Development of a Utilization Index as the amount of change in health status per visit.

In 1994 and 1995, new outpatient services of all types joined the FOTO database. The addition of hospitals, private practitioners, physician owned, and payer owned services has resulted in a well diversified mix of providers within the database.

1996 resulted in continued growth, but was highlighted by the addition of Ed Dobrzykowski, PT, ATC as Director of Development and his development of additional outcomes instruments for the more severely involved patient requiring care from multiple disciplines. Ed was CareMark Inc.'s representative on FOTO's initial governing board. The research agenda was highlighted by the substantiation of the predictability of resources required in outpatient rehabilitation.

1997 brought the addition of Dennis Hart PT, PhD as Director of Research and Consulting. Dennis was also a representative on FOTO's initial governing board from Rehability Inc.

In 1998, FOTO introduced "CADI" (Computer Assisted Data Input). CADI's user friendly interface allowed the patient and staff to answer FOTO questions on the computer, following on-screen prompts. Version 2.1 of FOTO's CADI software was released in September 2000 and has added Hispanic surveys, audible surveys (English and Hispanic), and FOTO Lite, a reduced data collection option for the clinician.

In 2001, FOTO introduced Patient Inquiry^®, a revolutionary computer adaptive testing (CAT) survey software. It is as much patient evaluation software as it is an outcome software. PI^® revolutionized outcomes data collection by creating the most efficient yet most functional outcomes survey.