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Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2017	Feb. 22, 2018	Jun. 30, 2017
Document And Entity Information [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2017
Document Fiscal Period Focus	FY
Trading Symbol	HSTM
Entity Registrant Name	HEALTHSTREAM INC
Entity Central Index Key	0001095565
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Filer Category	Large Accelerated Filer
Entity Common Stock, Shares Outstanding		32,040,067
Entity Public Float			$ 670.9

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Current assets:
Cash and cash equivalents	$ 84,768	$ 49,634
Marketable securities	46,350	53,540
Accounts receivable, net of allowance for doubtful accounts of $2,205 and $863 at December 31, 2017 and 2016, respectively	40,849	44,805
Accounts receivable -unbilled	2,602	2,581
Prepaid royalties, net of amortization	16,174	18,183
Other prepaid expenses and other current assets	8,985	8,694
Total current assets	199,728	177,437
Non-current assets:
Property and equipment, net of accumulated depreciation of $25,862 and $20,527 at December 31, 2017 and December 31, 2016, respectively	8,992	10,245
Capitalized software development, net of accumulated amortization of $41,884 and $31,787 at December 31, 2017 and 2016, respectively	18,697	16,310
Goodwill	110,298	109,765
Intangible assets, net	68,816	78,364
Non-marketable equity investments	3,772	3,276
Other assets	771	603
Total assets	411,074	396,000
Current liabilities:
Accounts payable	4,836	3,127
Accrued royalties	12,877	13,161
Accrued liabilities	11,062	8,146
Accrued compensation and related expenses	3,337	1,994
Deferred revenue	68,954	68,542
Total current liabilities	101,066	94,970
Deferred tax liabilities	1,926	5,968
Deferred revenue, noncurrent	6,302	7,859
Other long term liabilities	1,610	1,095
Commitments and contingencies
Shareholders' equity:
Common stock, no par value, 75,000 shares authorized; 31,908 and 31,748 shares issued and outstanding at December 31, 2017 and 2016, respectively	282,666	280,813
Retained earnings	17,542	5,346
Accumulated other comprehensive loss	(38)	(51)
Total shareholders' equity	300,170	286,108
Total liabilities and shareholders' equity	411,074	396,000
Customer-Related Intangible Assets [Member]
Non-current assets:
Intangible assets, net	59,958	66,446
Other Intangible Assets [Member]
Non-current assets:
Intangible assets, net	$ 8,858	$ 11,918

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Allowance for doubtful accounts, net	$ 2,205	$ 863
Accumulated depreciation on property and equipment	25,862	20,527
Accumulated amortization on capitalized software development	41,884	31,787
Accumulated amortization on intangible assets	$ 25,993	$ 16,445
Common stock, no par value
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	31,908,000	31,748,000
Common stock, shares outstanding	31,908,000	31,748,000
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 18,027	$ 11,539
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 7,966	$ 4,906

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Statement [Abstract]
Revenues, net	$ 247,662	$ 225,974	$ 209,002
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	106,000	96,634	89,386
Product development	27,899	28,897	24,214
Sales and marketing	42,915	39,004	35,589
Other general and administrative expenses	34,765	33,665	29,259
Depreciation and amortization	26,283	22,207	16,997
Total operating costs and expenses	237,862	220,407	195,445
Operating income	9,800	5,567	13,557
Other income, net	733	581	162
Income before income tax provision	10,533	6,148	13,719
Income tax provision	529	2,393	5,098
Net income	$ 10,004	$ 3,755	$ 8,621
Net income per share:
Basic	$ 0.31	$ 0.12	$ 0.29
Diluted	$ 0.31	$ 0.12	$ 0.28
Weighted average shares of common stock outstanding:
Basic	31,861	31,721	30,057
Diluted	32,196	32,068	30,436

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Statement of Comprehensive Income [Abstract]
Net income	$ 10,004	$ 3,755	$ 8,621
Other comprehensive income, net of taxes:
Unrealized gain (loss) on marketable securities	13	19	(33)
Total other comprehensive income (loss)	13	19	(33)
Comprehensive income	$ 10,017	$ 3,774	$ 8,588

Consolidated Statements of Shareholders' Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock [Member]	Retained Earnings (Accumulated Deficit) [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning balance at Dec. 31, 2014	$ 167,859	$ 174,926	$ (7,030)	$ (37)
Beginning balance, shares at Dec. 31, 2014		27,677
Net income	8,621		8,621
Comprehensive income (loss)	(33)			(33)
Issuance of common stock	98,014	$ 98,014
Issuance of common stock, shares		3,870
Stock donated to Company	0	$ 0	0	0
Stock donated to Company, shares		(54)
Stock based compensation	3,280	$ 3,280
Tax benefits from equity awards	3,008	3,008
Common stock issued under stock plans, net of shares withheld for employee taxes	(429)	$ (429)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		154
Ending balance at Dec. 31, 2015	280,320	$ 278,799	1,591	(70)
Ending balance, shares at Dec. 31, 2015		31,647
Net income	3,755		$ 3,755
Comprehensive income (loss)	19			$ 19
Stock based compensation	$ 1,968	$ 1,968
Stock based compensation , shares	0	0	0	0
Tax benefits from equity awards	$ 217	$ 217
Common stock issued under stock plans, net of shares withheld for employee taxes	(171)	$ (171)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		101
Ending balance at Dec. 31, 2016	$ 286,108	$ 280,813	$ 5,346	$ (51)
Ending balance, shares at Dec. 31, 2016	31,748	31,748
Cumulative effect of accounting change	$ 2,192		2,192
Net income	10,004		10,004
Comprehensive income (loss)	13			13
Stock based compensation	1,852	$ 1,852
Common stock issued under stock plans, net of shares withheld for employee taxes	1	$ 1
Common stock issued under stock plans, net of shares withheld for employee taxes, shares		160
Ending balance at Dec. 31, 2017	$ 300,170	$ 282,666	$ 17,542	$ (38)
Ending balance, shares at Dec. 31, 2017	31,908	31,908

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
OPERATING ACTIVITIES:
Net income	$ 10,004	$ 3,755	$ 8,621
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	26,283	22,207	16,997
Deferred income taxes	(2,045)	1,786	392
Share based compensation expense	1,852	1,968	3,280
Excess tax benefits from equity awards		(217)	(3,008)
Provision for doubtful accounts	1,813	640	284
Loss (gain) on non-marketable equity investments	5	(121)	117
Gain on sale of long-lived assets			(72)
Loss on disposal of fixed assets	97
Other	408	1,026	1,401
Changes in assets and liabilities, net of business combinations:
Accounts and unbilled receivables	1,125	(6,079)	(736)
Prepaid royalties	2,008	(4,008)	(1,006)
Other prepaid expenses and other current assets	(225)	(1,462)	(1,372)
Other assets	(168)	305	1,110
Accounts payable	2,284	(1,319)	(137)
Accrued royalties	(29)	3,691	(202)
Accrued liabilities, accrued compensation and related expenses, and other long-term liabilities	4,106	(884)	3,075
Deferred revenue	(806)	2,946	6,173
Net cash provided by operating activities	46,712	24,234	34,917
INVESTING ACTIVITIES:
Business combinations, net of cash acquired		(55,255)	(88,075)
Proceeds from maturities of marketable securities	90,073	119,395	54,799
Purchases of marketable securities	(83,279)	(106,965)	(84,228)
Payments to acquire equity method investments			(1,000)
Payments to acquire cost method investments	(500)		(1,000)
Proceeds for sale of long-lived assets		975
Payments associated with capitalized software development	(11,856)	(9,721)	(7,265)
Purchases of property and equipment	(6,017)	(5,085)	(8,094)
Net cash used in investing activities	(11,579)	(56,656)	(134,863)
FINANCING ACTIVITIES:
Proceeds from issuance of common stock			98,014
Proceeds from exercise of stock options	413	145	328
Proceeds from borrowings under revolving line of credit facility			28,000
Repayments under revolving line of credit facility			(28,000)
Taxes paid related to net settlement of equity awards	(412)	(316)	(756)
Excess tax benefits from equity awards		217	3,008
Payment of earn-outs related to business combinations			(633)
Net cash provided by financing activities	1	46	99,961
Net increase (decrease) in cash and cash equivalents	35,134	(32,376)	15
Cash and cash equivalents at beginning of year	49,634	82,010	81,995
Cash and cash equivalents at end of year	84,768	49,634	82,010
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid	101	76	190
Income taxes paid	$ 638	$ 2,496	2,648
NON-CASH INVESTING AND FINANCING ACTIVITIES:
Receivable from sale of long-lived assets			$ 975

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Reporting Entity and Segments

HealthStream, Inc. (the “Company”) was incorporated in 1990 as a Tennessee corporation and is headquartered in Nashville, Tennessee. As of December 31, 2017, the Company operated in three segments: HealthStream Workforce Solutions, HealthStream Patient Experience Solutions, and HealthStream Provider Solutions. Workforce Solutions products consist of software-as-a-service (“SaaS”) based services and subscription-based solutions to meet the ongoing training, certification, assessment, and development needs of the healthcare community. These solutions provide, deliver, and track online education for our customers in the United States through our SaaS model. Patient Experience products offer healthcare organizations a wide range of quality and satisfaction surveys, consulting services, analyses of survey results, and other research-based services. Provider Solutions products offer healthcare organizations software applications for administering and tracking provider credentialing, privileging, call center, and enrollment activities.

Recently Adopted Accounting Standards

The Company adopted the Financial Accounting Standards Board (“FASB”) Accounting Standards Update (“ASU”) 2016-09, Improvements to Employee Share-Based Payment Accounting, effective January 1, 2017. As a result of the adoption, the Company recorded an adjustment to retained earnings of approximately $2.2 million to recognize deferred tax assets associated with previous excess tax benefits on stock based compensation that had not been previously recognized because the related tax deduction had not reduced income taxes payable. The Company elected to continue to estimate expected forfeitures rather than account for them as they occur and to prospectively reflect the presentation of excess tax benefits on the statement of cash flows as an operating activity. In addition, effective January 1, 2017, excess tax benefits or deficiencies from equity based awards is reflected in the statement of income as a component of the provision for income taxes.

In January 2017, the FASB issued ASU 2017-04, Simplifying the Test for Goodwill Impairment, which simplifies the measurement of goodwill by eliminating Step 2 from the goodwill impairment test. With the elimination of Step 2, entities will measure goodwill for impairment by comparing the fair value of the reporting unit with its carrying amount. An impairment charge should be recognized for the amount by which the carrying amount exceeds the reporting unit’s fair value, only to the extent of the carrying value of goodwill allocated to that reporting unit. The Company elected to early adopt ASU 2017-04 effective January 1, 2017 and is required to apply the new guidance on a prospective basis. The adoption is not expected to have a material effect on the Company’s consolidated financial statements. The Company anticipates the new guidance will make the goodwill impairment evaluation process more efficient and cost effective.

Recognition of Revenue

Revenues are derived from providing services through our SaaS-based workforce development platform products, courseware subscriptions, provision of survey and research services, sales of software licensing arrangements, software maintenance and support, professional services, custom courseware development, and other education and training services.

The Company recognizes revenue when it is realized or realizable and earned. The Company considers revenue realized or realizable and earned when persuasive evidence of an arrangement exists, prices are fixed or determinable, services and products are provided to the customer and collectability is probable or reasonably assured.

Revenue recognized from software and other arrangements is allocated to each element of the arrangement based on the relative fair values of the elements. While elements include software products and post contract customer support, the fair value of each element is based on vendor specific objective evidence (“VSOE”). For installed software products, if fair value cannot be determined for each undelivered element of the arrangement, all revenue from the arrangement is deferred until fair value can be determined or until all elements of the arrangement are delivered and customer acceptance has occurred. Sales of the Company’s SaaS-based workforce development platform products include customer support, implementation services, and training; therefore all revenues are deferred until the SaaS-based product is implemented, at which time revenues are recognized ratably over the subscription service period. In the event that circumstances occur which give rise to uncertainty regarding the collectibility of contracted amounts, revenue recognition is suspended until such uncertainty is resolved. Fees for these services are billed on either a monthly, quarterly, or annual basis.

Revenues derived from the delivery of services through the Company’s SaaS-based workforce development platform products and courseware subscriptions are recognized ratably over the term of the subscription service agreement or over the historical usage period, if usage typically differs from the subscription period. Training revenues are generally recognized upon the completion of training.

Revenues derived from the license of installed software products are recognized using the residual method upon delivery of the software, when VSOE of fair value for the undelivered elements within the contract can be established. If the Company cannot objectively determine the fair value of each undelivered element based on the VSOE of fair value, the Company defers revenue recognition until all elements are delivered, all services have been performed, or until fair value can be objectively determined. Software support and maintenance revenues are recognized ratably over the term of the related agreement.

Revenues recognized from the Company’s survey and research services are determined using both the proportional performance method and the completed contract method. Revenues are generally earned over the estimated survey cycle, which typically ranges from less than one month to up to five months. The survey cycle is generally initiated based on the receipt of the first survey response and runs through provision of related survey reports to the customer. If survey results are not available to the customer during the survey fielding cycle, revenues are recognized at time of report delivery. Revenues for coaching and consulting engagements are recognized using the proportional performance method over the term of the underlying contract. Fees for survey services are billed upon initiation of the survey cycle, with progress billings made throughout the survey cycle. Fees for coaching and consulting engagements are billed upon initiation of the engagement with progress billings throughout the term of the contract.

Revenues from professional services and courseware development services are recognized upon the completion of performance milestones and deliverables using the proportional performance method. All other revenues are recognized as the related services are performed or products are delivered. Fees for these services are generally billed at project initiation and upon completion of various milestones.

Principles of Consolidation

The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

The consolidated financial statements are prepared in accordance with U.S. generally accepted accounting principles. These accounting principles require management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates and such differences could be material to the consolidated financial statements.

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities

Marketable securities are classified as available for sale and are stated at fair market value, with the unrealized gains and losses, net of tax, reported in other accumulated comprehensive income (loss) on the accompanying consolidated balance sheets. Realized gains and losses and declines in market value judged to be other than temporary on investments in marketable securities are included in interest and other income on the accompanying consolidated statements of income. The cost of securities sold is based on the specific identification method. Interest and dividends on securities classified as available for sale are included in other income (expense) on the accompanying consolidated statements of income. Premiums and discounts are amortized over the life of the related available for sale security as an adjustment to the yield using the effective interest method.

Accounts Receivable-Unbilled

Accounts receivable-unbilled represents the following: 1) revenue earned and recognized on contracts accounted for using the proportional performance method for which invoices have not been generated or contractual billing dates have not been reached; and 2) the difference between billings for contracts containing escalated pricing over the term of the agreement and the recognition of revenue ratably over the subscription period.

Deferred Revenue

Deferred revenue represents amounts that have been billed or collected in advance of revenue recognition. The Company typically invoices customers in quarterly, bi-annual, or annual installments. Deferred revenue is reduced as services are provided and the revenue recognition criteria are met.

Prepaid Royalties

Prepaid royalties represents advance payments associated with the sale of third party products, such as courseware subscriptions. Royalties are typically paid in advance at the commencement of the revenue cycle or periodically throughout the revenue cycle, such as quarterly, bi-annual, or annual installments. Royalty payments are amortized over the term of the underlying contracts, which generally range from 12 to 36 months, in order to match the direct royalty costs to the same period the subscription revenue is recognized. Amortization of royalties is included under the caption “cost of revenues (excluding depreciation and amortization)” in the accompanying consolidated statements of income.

Allowance for Doubtful Accounts

The Company estimates its allowance for doubtful accounts using a specific identification method in which management considers the facts and circumstances surrounding each potentially uncollectible receivable. An allowance is also maintained for accounts that are not specifically identified that may become uncollectible in the future. Uncollectible receivables are written-off in the period management believes it has exhausted every opportunity to collect payment from the customer. Bad debt expense is recorded when events or circumstances indicate an additional allowance is required based on the Company’s specific identification approach.

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):


	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2017	$	863	$	1,813	$	(471	)	$	2,205
2016	$	303	$	640	$	(80	)	$	863
2015	$	331	$	284	$	(312	)	$	303

Capitalized Software Development

Capitalized software development is stated on the basis of cost and is presented net of accumulated amortization. The Company capitalizes costs incurred during the software development phase for projects when such costs are material. These assets are generally amortized using the straight-line method over three years. The Company capitalized approximately $12.5 million and $10.0 million during 2017 and 2016, respectively. Amortization of capitalized software development was approximately $10.1 million, $7.7 million, and $6.2 million during 2017, 2016, and 2015, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2017 and 2016, there were no capitalized software development costs for external computer software developed for resale.

Fair Value Measurements

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in the principal or most advantageous market in an orderly transaction between market participants at the measurement date. The fair value hierarchy prioritizes the inputs to valuation techniques used in measuring fair value. There are three levels to the fair value hierarchy based on the reliability of inputs, as follows:

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

The Company evaluates assets and liabilities subject to fair value measurements on a recurring basis to determine the appropriate level at which to classify them for each reporting period. This determination requires significant judgments to be made by the Company. At December 31, 2017 and 2016, our assets measured at fair value on a recurring basis consisted of marketable securities, which are classified as available for sale (see Note 4 – Marketable Securities). The Company did not have any financial liabilities that were subject to fair value measurements as of such dates.

Property and Equipment

Property and equipment are stated on the basis of cost. Depreciation and amortization are provided on the straight-line method over the following estimated useful lives, except for assets under capital leases and leasehold improvements, which are amortized over the shorter of the estimated useful life or their respective lease term.


	Years
Furniture and fixtures		5
Equipment		3

Goodwill and Intangible Assets

Goodwill represents the excess of purchase price in a business combination over the fair value of the net identifiable assets acquired. The carrying amount of our goodwill is evaluated for impairment at least annually during the fourth quarter and whenever events or changes in facts or circumstances indicate that impairment may exist. In accordance with ASC 350, Intangibles – Goodwill and Other, companies may opt to first assess qualitative factors to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount. A qualitative assessment includes factors such as financial performance, industry and market metrics, and other factors affecting the reporting unit. If this assessment concludes that it is more likely than not that the fair value of a reporting unit exceeds its carrying value, then goodwill is not considered impaired and no further impairment testing is required. Conversely, if the qualitative assessment concludes that it is more likely than not that the fair value of a reporting unit is less than its carrying value, we must then compare the fair value of the reporting unit to its carrying value. The Company determines fair value of the reporting units using both income and market based models. These models require the use of various assumptions relating to cash flow projections, growth rates, discount rates and terminal value calculations. There were no goodwill impairments identified or recorded for the years ended December 31, 2017, 2016 or 2015.

As of December 31, 2017, intangible assets include customer relationships, internally-developed technology and patents, non-competition agreements, and trade names. These intangible assets are considered to have definite useful lives and are being amortized on a straight line basis over periods ranging between three and thirteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2017 was 11.1 years. Intangible assets are reviewed for impairment whenever events or changes in facts or circumstances indicate that the carrying amount of the assets may not be recoverable. There were no intangible asset impairments identified or recorded for the years ended December 31, 2017, 2016, or 2015.

Long-Lived Assets

Long-lived assets to be held for use are reviewed for events or changes in facts and circumstances, both internally and externally, which may indicate that an impairment of long-lived assets held for use is present. The Company measures any impairment using observable market values or discounted future cash flows from the related long-lived assets. The cash flow estimates and discount rates incorporate management’s best estimates, using appropriate and customary assumptions and projections at the date of evaluation. Management periodically evaluates whether the carrying value of long-lived assets, including intangible assets, property and equipment, capitalized software development, and other assets will be recoverable. There were no long-lived asset impairments identified or recorded for the years ended December 31, 2017, 2016, or 2015.

Non-Marketable Equity Investments

Non-marketable equity investments are accounted for using the equity method when the Company can exercise significant influence over the investee. Investments for which the Company is not able to exercise significant influence over the investee are accounted for under the cost method. The proportionate share of income or loss from equity method investments are recorded under the caption “other income, net” in the accompanying consolidated statements of income.

Financial Instruments

The Company has various financial instruments, including cash and cash equivalents, accounts receivable, accounts receivable-unbilled, accounts payable, accrued liabilities, and deferred revenue. The carrying amounts of these financial instruments approximate fair value because of the short term maturity or short term nature of such instruments. The Company also has marketable securities, which are recorded at approximate fair value based on quoted market prices or alternative pricing sources (see Note 4 – Marketable Securities).

Advertising

The Company expenses the costs of advertising as incurred. Advertising expense for the years ended December 31, 2017, 2016, and 2015 was approximately $1.0 million, $1.0 million, and $1.1 million, respectively.

Shipping and Handling Costs

Shipping and handling costs that are associated with our products and services are included in cost of revenues.

Income Taxes

Income taxes are accounted for using the asset and liability method, whereby deferred tax assets and liabilities are determined based on the temporary differences between the financial statement and tax bases of assets and liabilities measured at tax rates that will be in effect for the year in which the differences are expected to affect taxable income. Management evaluates all available evidence, both positive and negative, to determine whether, based on the weight of that evidence, a valuation allowance is needed. Future realization of the tax benefit of an existing deductible temporary difference or carryforward ultimately depends on the existence of sufficient taxable income of the appropriate character within the carryback or carryforward period available under the tax law. There are four possible sources of taxable income that may be available under the tax law to realize a tax benefit for deductible temporary differences and carryforwards: 1) future reversals of existing taxable temporary differences, 2) future taxable income exclusive of reversing temporary differences and carryforwards, 3) taxable income in prior carryback year(s) if carryback is permitted under the tax law, and 4) tax-planning strategies that would, if necessary, be implemented to realize deductible temporary differences or carryforwards prior to their expiration. Management reviews the realizability of its deferred tax assets each reporting period to identify whether any significant changes in circumstances or assumptions have occurred that could materially affect the realizability of deferred tax assets. As of December 31, 2017, the Company had established a valuation allowance of $1.1 million for the portion of its net deferred tax assets that are not more likely than not expected to be realized.

The Company accounts for income tax uncertainties using a more-likely-than-not recognition threshold based on the technical merits of the tax position taken. Tax positions that meet the more-likely-than-not recognition threshold are measured in order to determine the tax benefit to be recognized in the financial statements. The Company expenses any penalties or interest associated with tax obligations as general and administrative expenses and interest expense, respectively.

Earnings per Share

Basic earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing the net income for the period by the weighted average number of common and common equivalent shares outstanding during the period. Common equivalent shares are composed of incremental common shares issuable upon the exercise of stock options and restricted share units subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. Common equivalent shares that have an anti-dilutive effect on diluted net income per share have been excluded from the calculation of diluted weighted average shares outstanding for the years ended December 31, 2017, 2016, and 2015.

Concentrations of Credit Risk and Significant Customers

The Company’s credit risks relate primarily to cash and cash equivalents, marketable securities and accounts receivable. The Company places its temporary excess cash investments in high quality, short-term money market instruments. At times, such investments may be in excess of the FDIC insurance limits. Marketable securities consist primarily of investment grade corporate debt securities and certificates of deposit.

The Company sells its products and services to various companies in the healthcare industry that are located in the United States. Credit evaluations of our customers’ financial condition are performed on an ongoing basis, which generally require no collateral from customers. An allowance for doubtful accounts is maintained for potentially uncollectible accounts receivable. The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2017, 2016, or 2015.

Stock Based Compensation

As of December 31, 2017, the Company maintains three stock based compensation plans under which awards are outstanding, as described in Note 11. The Company accounts for stock based compensation using the fair-value based method for costs related to share-based payments, including stock options and restricted share units. The Company uses the Black Scholes option pricing model for calculating the fair value of option awards issued under its stock based compensation plan. The Company measures compensation cost of restricted share units based on the closing fair market value of the Company’s stock on the date of grant. Stock based compensation cost is measured at the grant date, based on the fair value of the award that is ultimately expected to vest, and is recognized as an expense over the requisite service period. The Company recognizes tax benefits from stock based compensation if an excess tax benefit is realized. Excess tax benefits are reflected in the statement of income as a component of the provision for income taxes when realized.

Newly Issued Accounting Standards

In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606), which supersedes the revenue recognition requirements in Topic 605, Revenue Recognition, and most industry-specific revenue recognition guidance throughout the Industry Topics of the Accounting Standards Codification. The updated guidance states that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. The guidance also provides for additional disclosures with respect to revenues and cash flows arising from contracts with customers. The standard will be effective for the first interim period within annual reporting periods beginning after December 15, 2017, and the Company will adopt the standard using the modified retrospective approach effective January 1, 2018. In preparation for adoption of the standard, the Company implemented internal controls and key system functionality to enable the preparation of financial information and has reached conclusions on key accounting assessments related to the standard.

The most significant impact of the standard relates to capitalizing costs to acquire contracts, which have historically been expensed as incurred. As of December 31, 2017, the Company’s sales commission plans have included multiple payments, including initial payments in the period a customer contract is obtained and deferred payments either 15 or 27 months after the initial payment. Under the standard, only the initial payment is subject to capitalization as the deferred payments require a substantive performance condition of the employee. These initial commission payments will be capitalized in the period a customer contract is obtained and will be amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit. The expected period of benefit is the contract term, except when the commission payment is expected to provide economic benefit to the Company for a period longer than the contract term, such as for new customer or incremental sales where renewals are expected and renewal commissions are not commensurate with initial commissions. Such commissions will be amortized over the greater of contract term or technological obsolescence period when the underlying contracted products are technology-based, such as for the SaaS-based platforms, or the expected customer relationship period when the underlying contracted products are not technology-based, such as for patient experience survey products.

Additionally, the standard impacts several of the Company’s revenue streams. The primary streams affected are professional services and patient experience surveys. For professional services, the identification of performance obligations and the related timing of revenue recognition is changing such that revenues will be recognized earlier, during the period of service delivery, rather than over the related product’s contractual term. For patient experience surveys, revenues will correlate to survey delivery, which approximates ratable recognition over the contractual term, rather than the current method of spreading quarterly revenue over the five-month life cycle of the patient experience survey cycle.

The Company will finalize its calculation of the financial impact of the adoption of this accounting standard on its future consolidated financial statements in the first quarter of 2018. The Company anticipates adjustments to retained earnings of no more than $10 million and $16 million, net of related tax effects, upon adoption for revenue recognition and sales commissions, respectively.

In January 2016, the FASB issued ASU 2016-01, Financial Instruments – Overall (Sub Topic 825-10), which addresses certain aspects of the recognition, measurement, presentation, and disclosure of financial instruments. The guidance will, among other things, require equity investments (except those accounted for under the equity method of accounting or those that result in consolidation of the investee) to be measured at fair value with changes in fair value recognized in net income. The standard will be effective for the first interim period within annual reporting periods beginning after December 15, 2017, and early adoption is permitted for only limited aspects of such guidance. The Company plans to adopt this ASU on January 1, 2018, and is currently reviewing this standard to assess the impact on its future consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842), which requires lessees to recognize assets and liabilities for most leases. The recognition, measurement and presentation of expenses and cash flows arising from a lease by a lessee is not expected to significantly change under such guidance; however, the Company is currently reviewing this standard to assess the impact on its future consolidated financial statements. The standard will be effective for the first interim period within annual reporting periods beginning after December 15, 2018, and early adoption is permitted. The Company expects to adopt this ASU on January 1, 2019, and is currently evaluating the impact that adoption of this ASU will have on its consolidated financial position and results of operations.

Shareholders' Equity	12 Months Ended
Shareholders' Equity	Dec. 31, 2017
Equity [Abstract]
Shareholders' Equity	2. SHAREHOLDERS’ EQUITY Common Stock The Company is authorized to issue up to 75 million shares of common stock. The number of common shares issued and outstanding as of December 31, 2017 and 2016 was approximately 31.9 million and 31.7 million, respectively. Preferred Stock The Company is authorized to issue up to 10 million shares of preferred stock in one or more series, having the relative voting powers, designations, preferences, rights and qualifications, limitations or restrictions, and other terms as the Board of Directors may fix in providing for the issuance of such series, without any vote or action of the shareholders.

Earnings Per Share

12 Months Ended

Dec. 31, 2017

Earnings Per Share [Abstract]

Earnings Per Share

3. EARNINGS PER SHARE

The following table sets forth the computation of basic and diluted earnings per share for the three years ended December 31, 2017 (in thousands, except per share amounts):


	2017		2016		2015
Numerator:
Net income	$	10,004	$	3,755	$	8,621

Denominator:
Weighted-average shares outstanding		31,861		31,721		30,057
Effect of dilutive shares		335		347		379

Weighted-average diluted shares		32,196		32,068		30,436


Basic earnings per share	$	0.31	$	0.12	$	0.29

Diluted earnings per share	$	0.31	$	0.12	$	0.28

Potentially dilutive shares representing approximately 58,000, 38,000, and 16,000 shares of common stock for the years ended December 31, 2017, 2016, and 2015, respectively, were excluded from the calculation of diluted earnings per share because their effect would have been anti-dilutive.

Marketable Securities

12 Months Ended

Dec. 31, 2017

Investments, Debt and Equity Securities [Abstract]

Marketable Securities

4. MARKETABLE SECURITIES

At December 31, 2017 and 2016, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):


	December 31, 2017
	Adjusted Cost		Unrealized Gains		Unrealized Losses		Fair Value
Level 2:
Corporate debt securities	$	41,900	$	1	$	(39)	$	41,862
Government-sponsored enterprise debt securities		4,488		1		(1)		4,488

Total	$	46,388	$	2	$	(40)	$	46,350


	December 31, 2016
	Adjusted Cost		Unrealized Gains		Unrealized Losses		Fair Value
Level 2:
Corporate debt securities	$	44,486	$	-	$	(50)	$	44,436
Government-sponsored enterprise debt securities		9,105		1		(2)		9,104

Total	$	53,591	$	1	$	(52)	$	53,540

The carrying amounts of the marketable securities reported in the consolidated balance sheets approximate fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of December 31, 2017, the Company does not consider any of its marketable securities to be other than temporarily impaired. During the years ended December 31, 2017 and 2016, the Company did not reclassify any items out of accumulated other comprehensive income to net income. All investments in marketable securities are classified as a current asset on the balance sheet because the underlying securities mature within one year from the balance sheet date.

Business Combinations

12 Months Ended

Dec. 31, 2017

Business Combinations [Abstract]

Business Combinations

5. BUSINESS COMBINATIONS

Morrisey Associates, Inc.

On August 8, 2016, Echo, Inc. (“Echo”), a wholly owned subsidiary of the Company, acquired all of the outstanding stock of Morrisey Associates, Inc. (“MAI”), a Chicago, Illinois based company that provides credentialing and privileging software to healthcare organizations. The acquisition of MAI allows the Company to expand its credentialing and privileging product offerings and solutions to healthcare organizations. The consideration paid for MAI consisted of approximately $48.0 million in cash, which the Company funded with cash on hand, and was not subject to any post-closing working capital or similar adjustment. The Company incurred approximately $953,000 in transaction costs, all of which were incurred during the year ended December 31, 2016. The transaction costs were recorded in other general and administrative expenses in the consolidated statements of income. The results of operations for MAI have been included in the Company’s consolidated financial statements from the date of acquisition and are also included in the HealthStream Provider Solutions segment.

A summary of the purchase price is as follows (in thousands):


Cash paid at closing	$	44,120
Cash held in escrow		3,880

Total consideration paid	$	48,000

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):


Accounts receivable, net	$	2,406
Prepaid royalties and other prepaid assets		187
Property and equipment		75
Deferred tax assets		1,377
Goodwill		21,000
Intangible assets		27,400
Accounts payable and accrued liabilities		(776)
Deferred revenue		(3,669)

Net assets acquired	$	48,000

The excess purchase price over the fair values of net tangible and intangible assets was recorded as goodwill. The fair values of tangible and identifiable intangible assets, deferred revenue, and other liabilities assumed were based on management’s estimates and assumptions. The goodwill balance was primarily attributed to the assembled workforce, additional market opportunities from offering MAI’s products, and expected synergies from integrating MAI with other products or other combined functional areas within the Company. During the three months ended September 30, 2017, the Company determined that a portion of the acquired accounts receivable required an adjustment to net realizable value and a portion of the assumed liabilities would not be satisfied and therefore recorded a measurement period adjustment, which on a net basis, increased goodwill by approximately $533,000. The measurement period adjustment has no effect on current period or prior period earnings. The goodwill balance, including the measurement period adjustment, is deductible for U.S. income tax purposes. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $8.3 million to an estimated fair value of $3.7 million. The $4.6 million write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):


	Fair value		Useful life

Customer relationships	$	21,400		13 years
Developed technology		5,400		5 years
Trade name		600		6 years

Total intangible assets subject to amortization	$	27,400

The amounts of revenue and operating loss of MAI included in the Company’s consolidated statement of income from the date of acquisition of August 8, 2016 to the period ending December 31, 2016 are as follows (in thousands):


Total revenues	$	2,581

Operating loss	$	(2,358)

The following unaudited pro forma financial information summarizes the combined results of operations of the Company and MAI, which was significant for purposes of the unaudited pro forma financial information disclosure, as though the companies were combined as of January 1, 2016 (in thousands, except per share data):


	Year Ended December 31,
	2017		2016
Total revenues	$	248,942	$	236,205

Net income	$	10,958	$	6,610

Basic earnings per share	$	0.34	$	0.21

Diluted earnings per share	$	0.34	$	0.21

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition such as adjustment for amortization of intangible assets, depreciation of property and equipment, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not indicative of what the Company’s results of operations would have been had the transaction occurred at the beginning of the period presented or to project the Company’s results of operations in any future period.

The unaudited pro forma financial information for the years ended December 31, 2017 and 2016 combines the historical results of the Company and MAI for the years ended December 31, 2017 and 2016 and the pro forma adjustments listed above.

HealthLine Systems

On March 16, 2015, the Company acquired all of the membership interests of HealthLine Systems, LLC (“HLS”), a San Diego, California based company that specializes in credentialing, privileging, call center, and quality management solutions for the healthcare industry. The acquisition of HLS enabled the Company to provide a comprehensive solution set for healthcare provider credentialing, privileging, enrollment, referral, onboarding, and analytics in support of HealthStream’s approach to talent management for healthcare organizations. The consideration paid for HLS consisted of approximately $90.5 million in cash (taking into account an estimated closing working capital adjustment and the payment of an incremental tax indemnification claim by the Company as noted below). The Company incurred approximately $1.3 million in transaction costs associated with the acquisition, of which $965,000 were incurred during the year ended December 31, 2015 and $329,000 were incurred during the year ended December 31, 2014. The transaction costs were recorded in other general and administrative expenses in the consolidated statements of income for such periods. The results of operations for HLS have been included in the Company’s consolidated financial statements from the date of acquisition, and are also included in the HealthStream Provider Solutions segment.

A summary of the purchase price is as follows (in thousands):


Cash paid	$	89,850
Cash held in escrow		679

Total consideration paid	$	90,529

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):


Cash	$	54
Accounts receivable, net		3,052
Prepaid assets		546
Property and equipment		200
Deferred tax assets		2,523
Goodwill		43,798
Intangible assets		47,200
Accounts payable and accrued liabilities		(1,085)
Deferred revenue		(5,979)

Net assets acquired	$	90,309

The total consideration paid does not equal the fair value of assets acquired and liabilities assumed due to the post measurement period adjustment discussed below. The excess of purchase price over the fair values of net tangible and intangible assets has been recorded as goodwill. The fair values of tangible and identifiable intangible assets, deferred tax assets, deferred revenue, and other liabilities are based on management’s estimates and assumptions. Included in the assets and liabilities assumed is an estimated indemnification asset of $300,000 and a contingent liability of $700,000, both of which are associated with tax liabilities. The contingent liability is measured based on management’s estimate of a range of probable outcomes. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering HLS’s products, and expected synergies from integrating HLS with other products or other combined functional areas within the Company. During the three months ended March 31, 2016, the Company received notice of an indemnification claim from the former owners of HLS pursuant to the terms of the membership interest purchase agreement. The terms of such agreement require the Company to indemnify such owners for incremental taxes incurred as the result of the structure of the acquisition, which had favorable tax aspects to the Company. The Company recorded a measurement period adjustment in relation to the claim that increased goodwill by approximately $2.2 million during the three months ended March 31, 2016. The additional goodwill is deductible for U.S. income tax purposes. The goodwill balance excluding such measurement period adjustment is also deductible for U.S. income tax purposes. During the three months ended September 30, 2016, the Company agreed to settle this indemnification claim for approximately $2.4 million in respect of such tax indemnification provision in the membership interest purchase agreement, a difference of approximately $200,000 from the $2.2 million measurement period adjustment. The Company surpassed the one year measurement period as of the period ended March 31, 2016; accordingly, in accordance with requisite accounting guidance, the $200,000 difference has been reflected as a charge against net income for the year ended December 31, 2016. The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $15.0 million to an estimated fair value of $6.0 million. The $9.0 million write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services.

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):


	Fair value		Useful life
Customer relationships	$	42,600		13 years
Developed technology		3,700		5 years
Trade names		900		6 years

Total intangible assets subject to amortization	$	47,200

The amounts of revenue and operating loss of HLS included in the Company’s consolidated statement of income from the date of acquisition of March 16, 2015 to the period ending December 31, 2015 are as follows (in thousands):


Total revenues	$	8,543

Operating loss	$	(2,541	)

The following unaudited pro forma financial information summarizes the combined results of operations of the Company and HLS, which was significant for purposes of the unaudited pro forma financial information disclosure, as though the companies were combined as of January 1, 2015 (in thousands, except per share data):


	Year Ended December 31,
	2016		2015
Total revenues	$	227,834	$	219,108

Net income	$	4,924	$	13,551

Basic earnings per share	$	0.16	$	0.45

Diluted earnings per share	$	0.15	$	0.44

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition such as adjustment for amortization of intangible assets, depreciation of property and equipment, fair value adjustments of acquired deferred revenue balances, and interest expense associated with borrowings under a revolving credit facility by the Company to partially fund the acquisition. The unaudited pro forma combined results of operations is for informational purposes only and is not indicative of what the Company’s results of operations would have been had the transaction occurred at the beginning of the period presented or to project the Company’s results of operations in any future period.

The unaudited pro forma financial information for the years ended December 31, 2016 and 2015 combines the historical results of the Company and HLS for the years ended December 31, 2016 and 2015 and the pro forma adjustments listed above.

Other Business Combinations

On June 30, 2016, the Company acquired all of the stock of Performance Management Services, Inc. (“PMSI”), a Company based in Tustin, California focused on competency-based performance development for nurses, for $4.0 million in cash and up to an additional $500,000 of contingent consideration. The acquisition, including associated transaction costs, is not considered material to the Company’s financial statements. The Company accounted for the acquisition as a business combination and has allocated the purchase consideration based on management’s estimates of fair value. The results of operations for PMSI are included in the Company’s consolidated financial statements from the date of acquisition and are included in the HealthStream Workforce Solutions segment.

On July 25, 2016, the Company purchased all of the outstanding stock of Nursing Registry Consultants Corporation (“Nurse Competency”) not previously held by the Company for approximately $1.0 million in cash and up to an additional $75,000 in contingent consideration. Nurse Competency provides SaaS-based clinical assessment and testing products to the healthcare industry. The Company previously held a 32% minority equity interest in Nurse Competency and had accounted for such interest as an equity method investment. The fair value of the minority equity interest as of the July 25, 2016 acquisition date was approximately $484,000 and was determined in accordance with the fair value of the controlling interest acquired with consideration given to acquisition premiums, where applicable. The Company recorded a gain of approximately $225,000 to account for the difference between the noted acquisition date fair value of the minority equity interest and the carrying value as of such date. The gain is included in other income (expense), net in the consolidated statement of income for the year ended December 31, 2016. The Company accounted for the acquisition as a business combination and has allocated the purchase consideration based on management’s estimates of fair value. The results of operations for Nurse Competency are included in the Company’s consolidated financial statements from the date of acquisition and are included in the HealthStream Workforce Solutions segment.

Property and Equipment

12 Months Ended

Dec. 31, 2017

Property, Plant and Equipment [Abstract]

Property and Equipment

6. PROPERTY AND EQUIPMENT

Property and equipment consist of the following:


	December 31,
	2017		2016
Equipment	$	25,396	$	20,885
Leasehold improvements		5,291		5,025
Furniture and fixtures		4,167		4,862

Gross property and equipment		34,854		30,772
Accumulated depreciation and amortization		(25,862)		(20,527)

Property and equipment, net	$	8,992	$	10,245

Depreciation of property and equipment totaled approximately $6.6 million, $6.8 million, and $5.3 million for the years ended December 31, 2017, 2016, and 2015, respectively.

Goodwill

12 Months Ended

Dec. 31, 2017

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill

7. GOODWILL

The changes in the carrying amount of goodwill for the years ended December 31, 2017 and 2016 are as follows (in thousands):


	Workforce		Patient Experience		Provider		Total
Balance at January 1, 2017	$	16,381	$	24,154	$	69,230	$	109,765
Acquisition of Morrisey Associates, Inc.		-		-		533		533

Balance at December 31, 2017	$	16,381	$	24,154	$	69,763	$	110,298


	Workforce		Patient Experience		Provider		Total
Balance at January 1, 2016	$	12,336	$	24,154	$	46,583	$	83,073
Acquisition of HealthLine Systems, LLC.		-		-		2,180		2,180
Acquisition of Morrisey Associates, Inc.		-		-		20,467		20,467
Other business combinations		4,045		-		-		4,045

Balance at December 31, 2016	$	16,381	$	24,154	$	69,230	$	109,765

During the three months ended September 30, 2017, the Company recorded approximately $533,000 of additional goodwill in relation to the August 2016 acquisition of Morrisey Associates, Inc. Such amount relates to the measurement period adjustment previously mentioned in Note 5 under the caption “Morrisey Associates, Inc.”

Intangible Assets

12 Months Ended

Dec. 31, 2017

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets

8. INTANGIBLE ASSETS

Intangible assets other than goodwill are considered to have finite useful lives. Customer-related intangibles include customer relationships and are amortized over their estimated useful lives ranging from five to thirteen years. Other intangible assets include non-competition agreements, technology and patents, and trade names and are amortized over their estimated useful lives ranging from three to nine years. Amounts presented below as of December 31, 2017 and December 31, 2016 are inclusive of identifiable intangible assets recorded in relation to our acquisitions of Morrisey Associates, Inc. and HealthLine Systems, LLC, as well as other business combinations (see Note 5 – Business Combinations). Amortization of intangible assets was approximately $9.5 million, $7.8 million, and $5.6 million for the years ended December 31, 2017, 2016, and 2015, respectively.

Identifiable intangible assets are comprised of the following (in thousands):


	As of December 31, 2017						As of December 31, 2016

	Gross Amount		Accumulated Amortization		Net		Gross Amount		Accumulated Amortization		Net
Customer related	$	77,985	$	(18,027)	$	59,958	$	77,985	$	(11,539)	$	66,446
Other		16,824		(7,966)		8,858		16,824		(4,906)		11,918

Total	$	94,809	$	(25,993)	$	68,816	$	94,809	$	(16,445)	$	78,364

The expected future annual amortization expense for the years ending December 31, is as follows (in thousands):


2018	$	9,438
2019		8,792
2020		8,139
2021		7,356
2022		6,277
Thereafter		28,814

Total	$	68,816

Business Segments

12 Months Ended

Dec. 31, 2017

Segment Reporting [Abstract]

Business Segments

9. BUSINESS SEGMENTS

The Company provides services to healthcare organizations and other members within the healthcare industry. The Company’s services are focused on the delivery of workforce development products and services (“HealthStream Workforce Solutions”), survey and research services (“HealthStream Patient Experience Solutions”), and provider credentialing, privileging, call center, and enrollment products and services (“HealthStream Provider Solutions”).

The Company measures segment performance based on operating income before income taxes and prior to the allocation of certain corporate overhead expenses, interest income, interest expense, gains and losses from equity investments, and depreciation. The Unallocated component below includes corporate functions, such as accounting, human resources, legal, investor relations, administrative and executive personnel, depreciation, a portion of amortization, and certain other expenses, which are not currently allocated in measuring segment performance. The following is the Company’s business segment information as of and for the years ended December 31, 2017, 2016 and 2015 (in thousands).


Revenues, net:	2017		2016		2015
Workforce Solutions	$	178,061	$	168,040	$	161,289
Patient Experience Solutions		32,763		33,850		34,193
Provider Solutions		36,838		24,084		13,520

Total revenues, net	$	247,662	$	225,974	$	209,002


Operating income:	2017		2016		2015
Workforce Solutions	$	33,579	$	37,329	$	39,986
Patient Experience Solutions		1,491		(522)		1,548
Provider Solutions		879		(2,443)		(2,559)
Unallocated		(26,149)		(28,797)		(25,418)

Total operating income	$	9,800	$	5,567	$	13,557


	Assets *				Purchases of long-lived assets						Depreciation and amortization
	2017		2016		2017		2016		2015		2017		2016		2015
Workforce Solutions	$	90,055	$	96,323	$	9,888	$	9,266	$	11,403	$	9,982	$	8,243	$	6,693
Patient Experience Solutions		34,198		35,988		2,764		1,123		2,007		1,510		1,144		1,061
Provider Solutions		150,797		155,011		3,619		2,026		332		8,147		6,061		3,986
Unallocated		136,024		108,678		1,762		2,135		1,617		6,644		6,759		5,257

Total	$	411,074	$	396,000	$	18,033	$	14,550	$	15,359	$	26,283	$	22,207	$	16,997

* Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, certain property and equipment, and intangible assets. Cash and cash equivalents and marketable securities are not allocated to individual segments, and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Income Taxes

12 Months Ended

Dec. 31, 2017

Income Tax Disclosure [Abstract]

Income Taxes

10. INCOME TAXES

The provision (benefit) for income taxes is comprised of the following (in thousands):


	Year Ended December 31,
	2017		2016		2015
Current federal	$	1,679	$	(271)	$	3,608
Current state		895		877		1,098
Deferred federal		(2,192)		1,489		501
Deferred state		147		298		(109)

Provision for income taxes	$	529	$	2,393	$	5,098

A reconciliation of income taxes at the statutory federal income tax rate to the provision for income taxes included in the accompanying consolidated statements of income is as follows (in thousands):


	Year Ended December 31,
	2017		2016		2015
Federal tax provision at the statutory rate	$	3,687	$	2,152	$	4,802
State income tax provision, net of federal benefit		424		539		673
Tax credits		(583)		(560)		(425)
Change in state valuation allowance		322		308		(8)
Tax Act revaluation of deferred tax balances		(2,685)		-		-
Other		(636)		(46)		56

Provision for income taxes	$	529	$	2,393	$	5,098

Management periodically assesses the realizability of its deferred tax assets, and to the extent that a recovery is not likely, a valuation allowance is established to reduce the deferred tax asset to the amount estimated to be recoverable. At December 31, 2017, a valuation allowance of $1.1 million exists.

As of December 31, 2017, the Company had state net operating loss carryforwards of $19.5 million. These loss carryforwards will expire in years 2018 through 2027. The Company is subject to income taxation at the federal and various state levels. The Company is subject to U.S. federal tax examinations for tax years 2015 through 2017. Loss carryforwards and credit carryforwards generated or utilized in years earlier than 2015 are also subject to examination and adjustment. The Company has completed examinations with the Internal Revenue Service for tax years 2013 and 2014. The Company has research and development tax credit carryforwards of $2.3 million that expire in varying amounts through 2037. As of December 31, 2017, the Company had alternative minimum tax credit carryforwards of $837,000 that are available to offset future regular tax liabilities and do not expire.

On December 22, 2017, the President signed into law the Tax Cuts and Jobs Act (the “Tax Act”), reducing the U.S. corporate income tax rate to 21% effective January 1, 2018. Under ASC 740, the effects of new legislation are recognized in the period that includes the date of enactment. The estimated impact as of December 31, 2017 was to remeasure our deferred tax liability by $2.7 million, which has been reflected in our effective tax rate reconciliation. This impact is our most reasonable estimate at this time; however, we are still analyzing certain aspects of the Tax Act and refining our calculations, which could potentially impact future taxable income.

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits at December 31, 2017 and 2016, are as follows (in thousands):


	December 31,
	2017		2016
Balance at beginning of year	$	397	$	658
Additions for tax positions in the current year		10		64
Reductions for tax positions of prior years		(47)		(325)

Balance at end of year	$	360	$	397

The Company recognized approximately $3,000 and $18,000 for interest and penalties related to unrecognized tax benefits within the provision for income taxes during the years ended December 31, 2017 and 2016, respectively. Unrecognized tax benefits included tax positions of approximately $337,000 and $350,000 at December 31, 2017 and 2016, respectively, that if recognized would impact the Company’s effective tax rate. The reduction for tax positions of prior years reflected in the table above as of December 31, 2017, relates to (a) an item considered to be effectively settled with the IRS, and (b) amended returns filed with the state of Wisconsin. The Company estimates that it is reasonably possible the liability for unrecognized tax benefits could decrease up to $23,000 within the next 12 months.

Deferred federal and state income taxes reflect the net tax effects of temporary differences between the carrying amounts of assets and liabilities for financial reporting purposes and the amounts used for income tax purposes. Significant components of deferred tax assets and deferred tax liabilities are as follows (in thousands):


	December 31,
	2017			2016
Deferred tax assets:
Allowance for doubtful accounts	$	548		$	332
Accrued liabilities		1,981			1,275
Tax credits		3,115			1,397
Stock based compensation		841			1,171
Deferred revenue		1,467			1,818
Depreciation		617			1,119
Basis difference on investments		327			316
Net operating loss carryforwards		1,015			743

Total deferred tax assets		9,911			8,171
Less: Valuation allowance		(1,110	)		(654	)

Deferred tax assets, net of valuation allowance		8,801			7,517
Deferred tax liabilities:
Deductible goodwill		2,917			3,267
Nondeductible intangible assets		1,330			2,523
Prepaid assets		1,881			1,894
Capitalized software development		4,599			5,801

Total deferred tax liabilities		10,727			13,485


Net deferred tax liabilities	$	(1,926	)	$	(5,968	)

Stock Based Compensation

12 Months Ended

Dec. 31, 2017

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock Based Compensation

11. STOCK BASED COMPENSATION

Stock Incentive Plans

The Company’s 2016 Omnibus Incentive Plan (“2016 Plan”), 2010 Stock Incentive Plan (“2010 Plan”), and 2000 Stock Incentive Plan (“2000 Plan”; collectively, the 2016 Plan, the 2010 Plan, and the 2000 Plan, referred to as the “Plan”) authorize the grant of options, restricted share units (“RSUs”), or other forms of stock based compensation to employees, officers, directors, and others, and such grants must be approved by the Compensation Committee of the Board of Directors. Options granted under the Plan have terms of no more than ten years, with certain restrictions. The Plan allows the Compensation Committee of the Board of Directors to determine the vesting period and parameters of each grant. The vesting period of the options and RSUs granted has historically ranged from immediate vesting to annual vesting up to four years, generally beginning one year after the grant date. As of December 31, 2017, approximately 1.3 million shares of unissued common stock remained reserved for future stock incentive grants under the 2016 Plan. The Company issues new shares of common stock when options are exercised or when RSUs become vested.

Stock Option Activity

A summary of activity and various other information relative to stock options for the year ended December 31, 2017 is presented in the tables below (in thousands, except exercise price).


			Weighted-
	Common		Average		Aggregate
	Shares		Exercise Price		Intrinsic Value
Outstanding at beginning of period		476	$	6.74
Granted		-		-
Exercised		(100)		4.13
Expired		-		-
Forfeited		-		-

Outstanding at end of period		376	$	7.44	$	5,912

Exercisable at end of period		376	$	7.44	$	5,912

The aggregate intrinsic value for stock options in the table above represents the total difference between the Company’s closing stock price on December 29, 2017 (the last trading day of the year) of $23.16 per share and the option exercise price, multiplied by the number of in-the-money options as of December 31, 2017. The weighted average remaining contractual term of options outstanding at December 31, 2017 was 0.9 years. Options exercisable at December 31, 2017 have a weighted average remaining contractual term of 0.9 years.

Other information relative to option activity during the three years ended December 31, 2017 is as follows (in thousands):


	2017		2016		2015
Total grant date fair value of stock options vested	$	-	$	-	$	232

Total intrinsic value of stock options exercised	$	1,973	$	820	$	1,662

Cash proceeds from exercise of stock options	$	413	$	145	$	328

Restricted Share Unit Activity

A summary of activity relative to RSUs for the year ended December 31, 2017 is as follows (in thousands, except weighted average grant date fair value):


			Weighted-
	Number of		Average			Aggregate
	RSU’s		Grant Date Fair Value			Intrinsic Value
Outstanding at beginning of period		253		$	23.36
Granted		111			23.43
Vested		(77)			24.21
Forfeited		(28)			23.39

Outstanding at end of period		259		$	23.13		$	6,002

The aggregate fair value of RSUs that vested during the year ended December 31, 2017 and 2016, as of the respective vesting dates, was approximately $1.9 million and $1.5 million, respectively. A portion of RSUs that vested in 2017 and 2016 were net-share settled such that the Company withheld shares with value equivalent to the employees’ minimum statutory obligation for the applicable income and other employment taxes, and remitted the cash to the appropriate taxing authorities. The total shares withheld for RSUs during 2017 and 2016 were 17,122 and 15,373, respectively, and were based on the value of the RSUs on their respective settlement dates as determined by the Company’s closing stock price. Total payments related to RSUs for the employees’ tax obligations to taxing authorities were approximately $412,000 in 2017, $316,000 in 2016, and $230,000 in 2015, and are reflected as a financing activity within the consolidated statements of cash flows. These net-share settlements had the effect of share repurchases by the Company as they reduced and retired the number of shares that would have otherwise been issued as a result of the vesting and did not represent an expense to the Company.

Stock Based Compensation

Total stock based compensation expense, which is recorded in our consolidated statements of income, recorded for the years ended December 31, is as follows (in thousands):


	Years Ended December 31,
	2017		2016		2015
Cost of revenues (excluding depreciation and amortization)	$	76	$	144	$	824
Product development		258		178		569
Sales and marketing		240		239		547
Other general and administrative		1,278		1,407		1,340

Total stock based compensation expense	$	1,852	$	1,968	$	3,280

The Company amortizes the fair value of all stock based awards, net of estimated forfeitures, on a straight-line basis over the requisite service period, which generally is the vesting period. As of December 31, 2017, total unrecognized compensation expense related to non-vested stock options and RSUs was approximately $3.4 million, net of estimated forfeitures, with a weighted average expense recognition period remaining of 2.56 years. The Company realized approximately $426,000 of excess tax benefits related to stock based awards during the year ended December 31, 2017, which was reflected in the statement of income as a component of the provision for income taxes.

Stock based compensation cost for RSUs is measured based on the closing fair market value of the Company’s stock on the date of grant. Stock based compensation cost for stock options is estimated at the grant date based on the fair value calculated using the Black-Scholes method. The Company did not grant any stock options during 2017, 2016, or 2015.

Stock Awards

During June 2015, the Company’s Chief Executive Officer (“CEO”), Robert A. Frist, Jr., entered into an agreement with the Company pursuant to which he contributed 54,241 of his personally owned shares of HealthStream, Inc. common stock to the Company, without any consideration paid to him. In connection with this contribution, the Company approved the grant of 49,310 shares of HealthStream, Inc. common stock to over 600 employees who were not otherwise eligible to receive equity awards and had at least one year of service with the Company. The Company recognized approximately $1.5 million of stock based compensation expense for these stock awards during the three months ended June 30, 2015 based on the closing fair market value of the Company’s stock on the date of the Company’s approval of these grants. In connection with these equity awards, effective in the second quarter of 2015, the Company withheld shares with value equivalent to the employees’ minimum statutory obligation for the applicable income and other employment taxes, and remitted the cash to the appropriate taxing authorities. The total shares withheld were 17,279, and were based on the value of the stock awards on the date of the Company’s approval of these grants, as determined by the Company’s closing stock price on that date. Total payments related to the employees’ tax obligations to taxing authorities for these stock awards were approximately $526,000, and are reflected as a financing activity within the consolidated statements of cash flows for the year ended December 31, 2015. These share withholdings had the effect of share repurchases by the Company as they reduced and retired the number of shares otherwise issuable as a result of the stock awards and did not represent an expense to the Company.

Employee Benefit Plan	12 Months Ended
Employee Benefit Plan	Dec. 31, 2017
Retirement Benefits [Abstract]
Employee Benefit Plan	12. EMPLOYEE BENEFIT PLAN 401(k) Plan The Company has a defined-contribution employee benefit plan (“401(k) Plan”) incorporating provisions of Section 401(k) of the Internal Revenue Code. Employees must have attained the age of 21 and have completed thirty days of service to be eligible to participate in the 401(k) Plan. Under the provisions of the 401(k) Plan, a plan member may make contributions, on a tax-deferred basis, subject to IRS limitations. The Company elected to provide eligible employees with matching contributions totaling approximately $909,000, $391,000, and $645,000 for the years ended December 31, 2017, 2016, and 2015, respectively.

Debt

12 Months Ended

Dec. 31, 2017

Debt Disclosure [Abstract]

Debt

13. DEBT

At December 31, 2017 and 2016, the Company had no debt outstanding.

Revolving Credit Facility

The Company entered into a First Amendment to Revolving Credit Agreement (“Revolving Credit Facility”), amending the Revolving Credit Facility, dated as of November 24, 2014 with SunTrust Bank (“SunTrust”), extending the maturity date to November 24, 2018. Under the Revolving Credit Facility, the Company may borrow up to $50.0 million, which includes a $5.0 million swing line sub-facility and a $5.0 million letter of credit sub-facility, as well as an accordion feature that allows the Company to increase the Revolving Credit Facility by a total of up to $25.0 million, subject to securing additional commitments from existing lenders or new lending institutions. The obligations under the Revolving Credit Facility are guaranteed by each of the Company’s subsidiaries. At the Company’s election, the borrowings under the Revolving Credit Facility bear interest at either (1) a rate per annum equal to the highest of SunTrust’s prime rate or 0.5% in excess of the Federal Funds Rate or 1.0% in excess of one-month LIBOR (the “Base Rate”), plus an applicable margin, or (2) the one, two, three, or six-month per annum LIBOR for deposits in the applicable currency (the “Eurocurrency Rate”), as selected by the Company, plus an applicable margin. The applicable margin for Eurocurrency Rate loans depends on the Company’s funded debt leverage ratio and varies from 1.50% to 2.00%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 1.50%. Commitment fees and letter of credit fees are also payable under the Revolving Credit Facility. Principal is payable in full at maturity on November 24, 2018, and there are no scheduled principal payments prior to maturity. The Company is required to pay a commitment fee ranging between 20 and 30 basis points per annum of the average daily unused portion of the Revolving Credit Facility, depending on the Company’s funded debt leverage ratio.

The purpose of the Revolving Credit Facility is for general working capital needs, permitted acquisitions (as defined in the Loan Agreement), and for stock repurchase and/or redemption transactions that the Company may authorize.

The Revolving Credit Facility contains certain covenants that, among other things, restrict additional indebtedness, liens and encumbrances, changes to the character of the Company’s business, acquisitions, asset dispositions, mergers and consolidations, sale or discount of receivables, creation or acquisitions of additional subsidiaries, and other matters customarily restricted in such agreements.

In addition, the Revolving Credit Facility requires the Company to meet certain financial tests, including, without limitation:

•

a funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not greater than 3.0 to 1.0; and

•

an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not less than 3.0 to 1.0.

As of December 31, 2017, the Company was in material compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of December 31, 2017 and there were no borrowings under the Revolving Credit Facility during the year ended December 31, 2017.

Leases

12 Months Ended

Dec. 31, 2017

Leases [Abstract]

Leases

14. LEASES

The Company has non-cancellable operating leases primarily for office space and hosting facilities. Some lease agreements contain provisions for escalating rent payments over the initial terms of the lease. The Company accounts for these leases by recognizing rent expense on a straight-line basis and adjusting the deferred rent expense liability for the difference between the straight-line rent expense and the amount of rent paid. The terms of the lease agreements generally provide the Company the option to renew. Total rent expense under all operating leases was approximately $7.6 million, $5.6 million, and $4.3 million, for the years ended December 31, 2017, 2016, and 2015, respectively.

Future rental payment commitments at December 31, 2017 under non-cancelable operating leases, with initial terms of one year or more, are as follows (in thousands):


2018	$	4,720
2019		3,495
2020		3,920
2021		3,750
2022		3,744
Thereafter		20,361

Total minimum lease payments	$	39,990

The Company subleases certain of its office space included above under non-cancellable leases and is due to receive future minimum rental payments of approximately $148,000 for the year ended December 31, 2018.

Collaborative Arrangement	12 Months Ended
Collaborative Arrangement	Dec. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Collaborative Arrangement	15. COLLABORATIVE ARRANGEMENT The Company participates in a collaborative arrangement, SimVentures^TM, with Laerdal Medical A/S (“Laerdal Medical”), which is ending effective March 1, 2018. The Company receives 50 percent of the profits or losses generated from this collaborative arrangement. The parties did not form a separate legal entity as part of the collaborative arrangement; therefore, the Company accounts for SimVentures as a collaborative arrangement in accordance with applicable accounting guidance. For the year ended December 31, 2017, the Company recorded approximately $2.2 million of revenues and $1.2 million of expenses related to the collaborative arrangement. For the year ended December 31, 2016, the Company recorded approximately $2.7 million of revenues and $1.4 million of expenses related to the collaborative arrangement. For the year ended December 31, 2015, the Company recorded approximately $2.2 million of revenues and $1.8 million of expenses related to the collaborative arrangement.

Litigation	12 Months Ended
Litigation	Dec. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Litigation	16. LITIGATION In connection with its business, the Company is from time to time involved in various legal actions. The litigation process is inherently uncertain and it is possible that the resolution of such matters might have a material adverse effect upon the financial condition and/or results of operations of the Company. However, in the opinion of the Company’s management, matters currently pending or threatened against the Company are not expected to have a material adverse effect on the financial position or results of operations of the Company.

Related Party Transactions	12 Months Ended
Related Party Transactions	Dec. 31, 2017
Related Party Transactions [Abstract]
Related Party Transactions	17. RELATED PARTY TRANSACTIONS During the three months ended June 30, 2015, the Company’s CEO, Robert A. Frist, Jr., entered into an agreement with the Company pursuant to which he contributed 54,241 of his personally owned shares of HealthStream, Inc. common stock to the Company, without any consideration paid to him. In connection with this contribution, the Company approved the grant of 49,310 shares of common stock to over 600 employees, with a fair market value of approximately $1.5 million. Mr. Frist contributed 4,931 of the contributed shares noted above to take into account the estimated Company costs, such as administrative expenses and employer payroll taxes associated with the grants (See Note 11).

Subsequent Events	12 Months Ended
Subsequent Events	Dec. 31, 2017
Subsequent Events [Abstract]
Subsequent Events	18. SUBSEQUENT EVENTS On February 12, 2018, the Company divested its Patient Experience (“PX”) business to Press Ganey Associates (“Press Ganey”) for $65.5 million in cash (subject to adjustment based on the working capital of the PX business at closing), of which $6.5 million will be held in escrow for a period of time following the sale as a source of recovery for indemnification claims by Press Ganey. The sale of the PX business was effected by (i) the contribution by the Company of specified assets and certain liabilities used in the PX business to a newly-formed wholly-owned subsidiary of the Company, and (ii) immediately thereafter, the sale by the Company to Press Ganey of all of the outstanding equity interests such wholly-owned subsidiary. In connection with such contribution, the Company retained certain liabilities related to the PX business. HealthStream anticipates recording a pre-tax book gain in the first quarter of 2018 on the sale of its PX business between $34.0 million to $38.0 million. This sale of the PX business resulted in the Company’s complete divestiture of the Company’s patient experience solutions business segment. With the proceeds from this transaction, the Board of Directors declared a $1.00 per common share special cash dividend payable on April 3, 2018 to shareholders of record on March 6, 2018.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Reporting Entity and Segments

Reporting Entity and Segments

Recently Adopted Accounting Standards

Recently Adopted Accounting Standards

Recognition of Revenue

Recognition of Revenue

Principles of Consolidation

Principles of Consolidation

The consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. All intercompany accounts and transactions have been eliminated in consolidation.

Use of Estimates

Use of Estimates

Cash Equivalents

Cash Equivalents

The Company considers cash equivalents to be unrestricted, highly liquid investments with initial maturities of less than three months.

Marketable Securities

Marketable Securities

Accounts Receivable-Unbilled

Accounts Receivable-Unbilled

Deferred Revenue

Deferred Revenue

Prepaid Royalties

Prepaid Royalties

Allowance for Doubtful Accounts

Allowance for Doubtful Accounts

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):


	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2017	$	863	$	1,813	$	(471	)	$	2,205
2016	$	303	$	640	$	(80	)	$	863
2015	$	331	$	284	$	(312	)	$	303

Capitalized Software Development

Capitalized Software Development

Fair Value Measurements

Fair Value Measurements

Level 1 – Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets.

Level 2 – Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly.

Level 3 – Unobservable inputs in which little or no market data exists, therefore requiring the Company to develop its own assumptions.

Property and Equipment

Property and Equipment


	Years
Furniture and fixtures		5
Equipment		3

Goodwill and Intangible Assets

Goodwill and Intangible Assets

Long-Lived Assets

Long-Lived Assets

Non-Marketable Equity Investments

Non-Marketable Equity Investments

Financial Instruments

Financial Instruments

Advertising

Advertising

Shipping and Handling Costs

Shipping and Handling Costs

Shipping and handling costs that are associated with our products and services are included in cost of revenues.

Income Taxes

Income Taxes

Earnings Per Share

Earnings per Share

Concentrations of Credit Risk and Significant Customers

Concentrations of Credit Risk and Significant Customers

Stock Based Compensation

Stock Based Compensation

Newly Issued Accounting Standards

Newly Issued Accounting Standards

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2017

Accounting Policies [Abstract]

Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense

Changes in the allowance for doubtful accounts and the amounts charged to bad debt expense for the years ended December 31 were as follows (in thousands):


	Allowance Balance at Beginning of Period		Charged to Costs and Expenses		Write-offs			Allowance Balance at End of Period
2017	$	863	$	1,813	$	(471	)	$	2,205
2016	$	303	$	640	$	(80	)	$	863
2015	$	331	$	284	$	(312	)	$	303

Estimated Useful Lives of Property and Equipment


	Years
Furniture and fixtures		5
Equipment		3

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2017

Earnings Per Share [Abstract]

Computation of Basic and Diluted Earnings Per Share

The following table sets forth the computation of basic and diluted earnings per share for the three years ended December 31, 2017 (in thousands, except per share amounts):


	2017		2016		2015
Numerator:
Net income	$	10,004	$	3,755	$	8,621

Denominator:
Weighted-average shares outstanding		31,861		31,721		30,057
Effect of dilutive shares		335		347		379

Weighted-average diluted shares		32,196		32,068		30,436


Basic earnings per share	$	0.31	$	0.12	$	0.29

Diluted earnings per share	$	0.31	$	0.12	$	0.28

Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2017

Investments, Debt and Equity Securities [Abstract]

Fair Value of Available for Sale Marketable Securities

At December 31, 2017 and 2016, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):


	December 31, 2017
	Adjusted Cost		Unrealized Gains		Unrealized Losses		Fair Value
Level 2:
Corporate debt securities	$	41,900	$	1	$	(39)	$	41,862
Government-sponsored enterprise debt securities		4,488		1		(1)		4,488

Total	$	46,388	$	2	$	(40)	$	46,350


	December 31, 2016
	Adjusted Cost		Unrealized Gains		Unrealized Losses		Fair Value
Level 2:
Corporate debt securities	$	44,486	$	-	$	(50)	$	44,436
Government-sponsored enterprise debt securities		9,105		1		(2)		9,104

Total	$	53,591	$	1	$	(52)	$	53,540

Business Combinations (Tables)

12 Months Ended

Dec. 31, 2017

Morrisey Associates Inc [Member]

Summary of Purchase Price

A summary of the purchase price is as follows (in thousands):


Cash paid at closing	$	44,120
Cash held in escrow		3,880

Total consideration paid	$	48,000

Summary of Fair Value of Assets Acquired and Liabilities Assumed

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):


Accounts receivable, net	$	2,406
Prepaid royalties and other prepaid assets		187
Property and equipment		75
Deferred tax assets		1,377
Goodwill		21,000
Intangible assets		27,400
Accounts payable and accrued liabilities		(776)
Deferred revenue		(3,669)

Net assets acquired	$	48,000

Components of Identifiable Intangible Assets and Estimated Useful Lives

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):


	Fair value		Useful life

Customer relationships	$	21,400		13 years
Developed technology		5,400		5 years
Trade name		600		6 years

Total intangible assets subject to amortization	$	27,400

Summary of Unaudited ProForma Financial Information


Total revenues	$	2,581

Operating loss	$	(2,358)


	Year Ended December 31,
	2017		2016
Total revenues	$	248,942	$	236,205

Net income	$	10,958	$	6,610

Basic earnings per share	$	0.34	$	0.21

Diluted earnings per share	$	0.34	$	0.21

HealthLine Systems LLC [Member]

Summary of Purchase Price

A summary of the purchase price is as follows (in thousands):


Cash paid	$	89,850
Cash held in escrow		679

Total consideration paid	$	90,529

Summary of Fair Value of Assets Acquired and Liabilities Assumed

The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands):


Cash	$	54
Accounts receivable, net		3,052
Prepaid assets		546
Property and equipment		200
Deferred tax assets		2,523
Goodwill		43,798
Intangible assets		47,200
Accounts payable and accrued liabilities		(1,085)
Deferred revenue		(5,979)

Net assets acquired	$	90,309

Components of Identifiable Intangible Assets and Estimated Useful Lives

The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands):


	Fair value		Useful life
Customer relationships	$	42,600		13 years
Developed technology		3,700		5 years
Trade names		900		6 years

Total intangible assets subject to amortization	$	47,200

Summary of Unaudited ProForma Financial Information


Total revenues	$	8,543

Operating loss	$	(2,541	)


	Year Ended December 31,
	2016		2015
Total revenues	$	227,834	$	219,108

Net income	$	4,924	$	13,551

Basic earnings per share	$	0.16	$	0.45

Diluted earnings per share	$	0.15	$	0.44

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2017

Property, Plant and Equipment [Abstract]

Summary of Property and Equipment

Property and equipment consist of the following:


	December 31,
	2017		2016
Equipment	$	25,396	$	20,885
Leasehold improvements		5,291		5,025
Furniture and fixtures		4,167		4,862

Gross property and equipment		34,854		30,772
Accumulated depreciation and amortization		(25,862)		(20,527)

Property and equipment, net	$	8,992	$	10,245

Goodwill (Tables)

12 Months Ended

Dec. 31, 2017

Goodwill and Intangible Assets Disclosure [Abstract]

Changes in Carrying Amount of Goodwill

The changes in the carrying amount of goodwill for the years ended December 31, 2017 and 2016 are as follows (in thousands):


	Workforce		Patient Experience		Provider		Total
Balance at January 1, 2017	$	16,381	$	24,154	$	69,230	$	109,765
Acquisition of Morrisey Associates, Inc.		-		-		533		533

Balance at December 31, 2017	$	16,381	$	24,154	$	69,763	$	110,298


	Workforce		Patient Experience		Provider		Total
Balance at January 1, 2016	$	12,336	$	24,154	$	46,583	$	83,073
Acquisition of HealthLine Systems, LLC.		-		-		2,180		2,180
Acquisition of Morrisey Associates, Inc.		-		-		20,467		20,467
Other business combinations		4,045		-		-		4,045

Balance at December 31, 2016	$	16,381	$	24,154	$	69,230	$	109,765

Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2017

Goodwill and Intangible Assets Disclosure [Abstract]

Identifiable Intangible Assets

Identifiable intangible assets are comprised of the following (in thousands):


	As of December 31, 2017						As of December 31, 2016

	Gross Amount		Accumulated Amortization		Net		Gross Amount		Accumulated Amortization		Net
Customer related	$	77,985	$	(18,027)	$	59,958	$	77,985	$	(11,539)	$	66,446
Other		16,824		(7,966)		8,858		16,824		(4,906)		11,918

Total	$	94,809	$	(25,993)	$	68,816	$	94,809	$	(16,445)	$	78,364

Expected Annual Amortization Expense

The expected future annual amortization expense for the years ending December 31, is as follows (in thousands):


2018	$	9,438
2019		8,792
2020		8,139
2021		7,356
2022		6,277
Thereafter		28,814

Total	$	68,816

Business Segments (Tables)

12 Months Ended

Dec. 31, 2017

Segment Reporting [Abstract]

Business Segment Information Based on Net Revenues

The following is the Company’s business segment information as of and for the years ended December 31, 2017, 2016 and 2015 (in thousands).


Revenues, net:	2017		2016		2015
Workforce Solutions	$	178,061	$	168,040	$	161,289
Patient Experience Solutions		32,763		33,850		34,193
Provider Solutions		36,838		24,084		13,520

Total revenues, net	$	247,662	$	225,974	$	209,002

Business Segment Information Based on Operating Income

Operating income:	2017		2016		2015
Workforce Solutions	$	33,579	$	37,329	$	39,986
Patient Experience Solutions		1,491		(522)		1,548
Provider Solutions		879		(2,443)		(2,559)
Unallocated		(26,149)		(28,797)		(25,418)

Total operating income	$	9,800	$	5,567	$	13,557

Business Segment Information Based on Assets


	Assets *				Purchases of long-lived assets						Depreciation and amortization
	2017		2016		2017		2016		2015		2017		2016		2015
Workforce Solutions	$	90,055	$	96,323	$	9,888	$	9,266	$	11,403	$	9,982	$	8,243	$	6,693
Patient Experience Solutions		34,198		35,988		2,764		1,123		2,007		1,510		1,144		1,061
Provider Solutions		150,797		155,011		3,619		2,026		332		8,147		6,061		3,986
Unallocated		136,024		108,678		1,762		2,135		1,617		6,644		6,759		5,257

Total	$	411,074	$	396,000	$	18,033	$	14,550	$	15,359	$	26,283	$	22,207	$	16,997

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2017

Income Tax Disclosure [Abstract]

Summary of Provision (Benefit) for Income Taxes

The provision (benefit) for income taxes is comprised of the following (in thousands):


	Year Ended December 31,
	2017		2016		2015
Current federal	$	1,679	$	(271)	$	3,608
Current state		895		877		1,098
Deferred federal		(2,192)		1,489		501
Deferred state		147		298		(109)

Provision for income taxes	$	529	$	2,393	$	5,098

Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes


	Year Ended December 31,
	2017		2016		2015
Federal tax provision at the statutory rate	$	3,687	$	2,152	$	4,802
State income tax provision, net of federal benefit		424		539		673
Tax credits		(583)		(560)		(425)
Change in state valuation allowance		322		308		(8)
Tax Act revaluation of deferred tax balances		(2,685)		-		-
Other		(636)		(46)		56

Provision for income taxes	$	529	$	2,393	$	5,098

Reconciliation of the Beginning and Ending liability for Gross Unrecognized Tax Benefits

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits at December 31, 2017 and 2016, are as follows (in thousands):


	December 31,
	2017		2016
Balance at beginning of year	$	397	$	658
Additions for tax positions in the current year		10		64
Reductions for tax positions of prior years		(47)		(325)

Balance at end of year	$	360	$	397

Significant Components of Deferred Tax Assets and Deferred Tax Liabilities

Significant components of deferred tax assets and deferred tax liabilities are as follows (in thousands):


	December 31,
	2017			2016
Deferred tax assets:
Allowance for doubtful accounts	$	548		$	332
Accrued liabilities		1,981			1,275
Tax credits		3,115			1,397
Stock based compensation		841			1,171
Deferred revenue		1,467			1,818
Depreciation		617			1,119
Basis difference on investments		327			316
Net operating loss carryforwards		1,015			743

Total deferred tax assets		9,911			8,171
Less: Valuation allowance		(1,110	)		(654	)

Deferred tax assets, net of valuation allowance		8,801			7,517
Deferred tax liabilities:
Deductible goodwill		2,917			3,267
Nondeductible intangible assets		1,330			2,523
Prepaid assets		1,881			1,894
Capitalized software development		4,599			5,801

Total deferred tax liabilities		10,727			13,485


Net deferred tax liabilities	$	(1,926	)	$	(5,968	)

Stock Based Compensation (Tables)

12 Months Ended

Dec. 31, 2017

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Summary of Activity and Various Other Information Relative to Stock Options

A summary of activity and various other information relative to stock options for the year ended December 31, 2017 is presented in the tables below (in thousands, except exercise price).


			Weighted-
	Common		Average		Aggregate
	Shares		Exercise Price		Intrinsic Value
Outstanding at beginning of period		476	$	6.74
Granted		-		-
Exercised		(100)		4.13
Expired		-		-
Forfeited		-		-

Outstanding at end of period		376	$	7.44	$	5,912

Exercisable at end of period		376	$	7.44	$	5,912

Other Information Relative to Option Activity

Other information relative to option activity during the three years ended December 31, 2017 is as follows (in thousands):


	2017		2016		2015
Total grant date fair value of stock options vested	$	-	$	-	$	232

Total intrinsic value of stock options exercised	$	1,973	$	820	$	1,662

Cash proceeds from exercise of stock options	$	413	$	145	$	328

Summary of Activity Relative to RSU's

A summary of activity relative to RSUs for the year ended December 31, 2017 is as follows (in thousands, except weighted average grant date fair value):


			Weighted-
	Number of		Average			Aggregate
	RSU’s		Grant Date Fair Value			Intrinsic Value
Outstanding at beginning of period		253		$	23.36
Granted		111			23.43
Vested		(77)			24.21
Forfeited		(28)			23.39

Outstanding at end of period		259		$	23.13		$	6,002

Stock Based Compensation Expense Recorded in Consolidated Statements of Income

Total stock based compensation expense, which is recorded in our consolidated statements of income, recorded for the years ended December 31, is as follows (in thousands):


	Years Ended December 31,
	2017		2016		2015
Cost of revenues (excluding depreciation and amortization)	$	76	$	144	$	824
Product development		258		178		569
Sales and marketing		240		239		547
Other general and administrative		1,278		1,407		1,340

Total stock based compensation expense	$	1,852	$	1,968	$	3,280

Leases (Tables)

12 Months Ended

Dec. 31, 2017

Leases [Abstract]

Future Rental Payment Commitments under Non-Cancelable Operating Leases

Future rental payment commitments at December 31, 2017 under non-cancelable operating leases, with initial terms of one year or more, are as follows (in thousands):


2018	$	4,720
2019		3,495
2020		3,920
2021		3,750
2022		3,744
Thereafter		20,361

Total minimum lease payments	$	39,990

Summary of Significant Accounting Policies - Additional Information (Detail)		3 Months Ended	12 Months Ended
	Dec. 31, 2017 USD ($) Plans	Mar. 31, 2018 USD ($)	Dec. 31, 2017 USD ($) Segment SourcesofTaxableIncome	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Business And Basis Of Presentation [Line Items]
Number of operating segments \| Segment			3
Adjustments to retained earnings			$ 2,192,000
Maturity of unrestricted cash equivalent			Less than three months
Assets amortized cost			3 years
Capitalized software development amount	$ 12,500,000		$ 12,500,000	$ 10,000,000
Amortization of capitalized software development			10,100,000	7,700,000	$ 6,200,000
Capitalized software development costs for external computer software developed for resale	0		0	0
Goodwill impairments identified or recorded			0	0	0
Impairments identified or recorded			0	0	0
Impairments identified or recorded for long-lived assets			0	0	0
Advertising expense			$ 1,000,000	1,000,000	$ 1,100,000
Number of sources of taxable income \| SourcesofTaxableIncome			4
Valuation allowance	$ 1,110,000		$ 1,110,000	$ 654,000
Concentration risk, customer			The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2017, 2016, or 2015.
Number of stock based compensation plans \| Plans	3
Accounting Standards Update 2014-09 [Member]
Business And Basis Of Presentation [Line Items]
Revenue spreading life cycle period			5 months
Accounting Standards Update 2016-09 [Member]
Business And Basis Of Presentation [Line Items]
Adjustments to retained earnings			$ 2,200,000
Minimum [Member]
Business And Basis Of Presentation [Line Items]
Revenues earned over the estimated survey cycle, period			1 month
Royalty payments amortization period			12 months
Finite lived intangible assets amortization period			3 years
Minimum [Member] \| Accounting Standards Update 2014-09 [Member]
Business And Basis Of Presentation [Line Items]
Sales commission deferred payments period			15 months
Maximum [Member]
Business And Basis Of Presentation [Line Items]
Revenues earned over the estimated survey cycle, period			5 months
Royalty payments amortization period			36 months
Finite lived intangible assets amortization period			13 years
Maximum [Member] \| Accounting Standards Update 2014-09 [Member]
Business And Basis Of Presentation [Line Items]
Sales commission deferred payments period			27 months
Maximum [Member] \| Revenue Recognition [Member] \| Accounting Standards Update 2014-09 [Member] \| Subsequent Event [Member]
Business And Basis Of Presentation [Line Items]
Adjustments to retained earnings		$ 10,000,000
Maximum [Member] \| Sales Commissions [Member] \| Accounting Standards Update 2014-09 [Member] \| Subsequent Event [Member]
Business And Basis Of Presentation [Line Items]
Adjustments to retained earnings		$ 16,000,000
Weighted Average [Member]
Business And Basis Of Presentation [Line Items]
Finite lived intangible assets amortization period			11 years 4 days

Summary of Significant Accounting Policies - Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Accounting Policies [Abstract]
Allowance Balance at Beginning of Period	$ 863	$ 303	$ 331
Charged to Costs and Expenses	1,813	640	284
Write-offs	(471)	(80)	(312)
Allowance Balance at End of Period	$ 2,205	$ 863	$ 303

Summary of Significant Accounting Policies - Estimated Useful Lives of Property and Equipment (Detail)	12 Months Ended
	Dec. 31, 2017
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	5 years
Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	3 years

Shareholders Equity - Additional Information (Detail) - shares	Dec. 31, 2017	Dec. 31, 2016
Class of Stock [Line Items]
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	31,908,000	31,748,000
Common stock, shares outstanding	31,908,000	31,748,000
Maximum [Member]
Class of Stock [Line Items]
Common stock, shares authorized	75,000,000
Preferred stock, shares authorized	10,000,000

Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Numerator:
Net income	$ 10,004	$ 3,755	$ 8,621
Denominator:
Weighted-average shares outstanding	31,861	31,721	30,057
Effect of dilutive shares	335	347	379
Weighted-average diluted shares	32,196	32,068	30,436
Basic earnings per share	$ 0.31	$ 0.12	$ 0.29
Diluted earnings per share	$ 0.31	$ 0.12	$ 0.28

Earnings Per Share - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Earnings Per Share [Abstract]
Total number of common equivalent shares excluded from the calculations of diluted earnings per share	58,000	38,000	16,000

Marketable Securities - Fair Value of Available for Sale Marketable Securities (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Fair Value	$ 46,350	$ 53,540
Level 2 [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	46,388	53,591
Available for sale securities, Unrealized Gains	2	1
Available for sale securities, Unrealized Losses	(40)	(52)
Available for sale securities, Fair Value	46,350	53,540
Level 2 [Member] \| Corporate Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	41,900	44,486
Available for sale securities, Unrealized Gains	1
Available for sale securities, Unrealized Losses	(39)	(50)
Available for sale securities, Fair Value	41,862	44,436
Level 2 [Member] \| Government-Sponsored Enterprises Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Available for sale securities, Adjusted Cost	4,488	9,105
Available for sale securities, Unrealized Gains	1	1
Available for sale securities, Unrealized Losses	(1)	(2)
Available for sale securities, Fair Value	$ 4,488	$ 9,104

Business Combinations - Additional Information (Detail) - USD ($)				1 Months Ended	3 Months Ended			12 Months Ended				15 Months Ended
	Aug. 08, 2016	Jul. 25, 2016	Mar. 16, 2015	Jun. 30, 2016	Sep. 30, 2017	Sep. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2014	Mar. 31, 2015
Nursing Registry Consultants Corporation [Member]
Business Acquisition [Line Items]
Equity method ownership interest percentage		32.00%
Fair value of minority equity interest		$ 484,000
HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Acquisition date of assets								Mar. 16, 2015
Consideration paid for acquisition in cash			$ 90,529,000
Transaction costs associated with the acquisition										$ 965,000	$ 329,000	$ 1,300,000
Adjustment to goodwill							$ 2,200,000
Net tangible assets include deferred revenue book value at acquisition date								$ 15,000,000
Net tangible assets include deferred revenue fair value at acquisition date								6,000,000
Write-down of deferred revenue								9,000,000
Estimated indemnification asset								300,000
Contingent liability								$ 700,000
Preliminary purchase price allocation measurement period								1 year
Goodwill indemnification claim						$ 2,400,000
Tax indemnification, charge against net income						$ 200,000			$ 200,000
Other Business Combination [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash				$ 4,000,000
Additional contingent consideration				$ 500,000
Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Acquisition date of assets								Aug. 08, 2016
Consideration paid for acquisition in cash	$ 48,000,000
Transaction costs associated with the acquisition									$ 953,000
Adjustment to goodwill					$ 533,000
Net tangible assets include deferred revenue book value at acquisition date	8,300,000
Net tangible assets include deferred revenue fair value at acquisition date	3,700,000
Write-down of deferred revenue	$ 4,600,000
Nursing Registry Consultants Corporation [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash		1,000,000
Additional contingent consideration		75,000
Recorded gain after business combination		$ 225,000

Business Combinations - Summary of Purchase Price (Detail) - USD ($) $ in Thousands	Aug. 08, 2016	Mar. 16, 2015
HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Total consideration paid		$ 90,529
Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 48,000
Cash Paid [Member] \| HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Total consideration paid		89,850
Cash Paid [Member] \| Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Total consideration paid	44,120
Cash Held in Escrow [Member] \| HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Total consideration paid		$ 679
Cash Held in Escrow [Member] \| Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 3,880

Business Combinations - Summary of Fair Value of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016	Aug. 08, 2016	Dec. 31, 2015	Mar. 16, 2015
Business Acquisition [Line Items]
Goodwill	$ 110,298	$ 109,765		$ 83,073
HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Cash					$ 54
Accounts receivable, net					3,052
Prepaid royalties and other prepaid assets					546
Property and equipment					200
Deferred tax assets					2,523
Goodwill					43,798
Intangible assets					47,200
Accounts payable and accrued liabilities					(1,085)
Deferred revenue					(5,979)
Net assets acquired					$ 90,309
Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Accounts receivable, net			$ 2,406
Prepaid royalties and other prepaid assets			187
Property and equipment			75
Deferred tax assets			1,377
Goodwill			21,000
Intangible assets			27,400
Accounts payable and accrued liabilities			(776)
Deferred revenue			(3,669)
Net assets acquired			$ 48,000

Business Combinations - Components of Identifiable Intangible Assets and Estimated Useful Lives (Detail) - USD ($) $ in Thousands	Aug. 08, 2016	Mar. 16, 2015
Morrisey Associates Inc [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets subject to amortization	$ 27,400
HealthLine Systems LLC [Member]
Finite-Lived Intangible Assets [Line Items]
Total intangible assets subject to amortization		$ 47,200
Customer Relationships [Member] \| Morrisey Associates Inc [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives	13 years
Total intangible assets subject to amortization	$ 21,400
Customer Relationships [Member] \| HealthLine Systems LLC [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives		13 years
Total intangible assets subject to amortization		$ 42,600
Developed Technology [Member] \| Morrisey Associates Inc [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives	5 years
Total intangible assets subject to amortization	$ 5,400
Developed Technology [Member] \| HealthLine Systems LLC [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives		5 years
Total intangible assets subject to amortization		$ 3,700
Trade Names [Member] \| Morrisey Associates Inc [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives	6 years
Total intangible assets subject to amortization	$ 600
Trade Names [Member] \| HealthLine Systems LLC [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful lives		6 years
Total intangible assets subject to amortization		$ 900

Business Combinations - Summary of Unaudited ProForma Financial Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	5 Months Ended	9 Months Ended	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
HealthLine Systems LLC [Member]
Business Acquisition [Line Items]
Total revenues		$ 8,543
Operating loss		$ (2,541)
Total revenues				$ 227,834	$ 219,108
Net income				$ 4,924	$ 13,551
Basic earnings per share				$ 0.16	$ 0.45
Diluted earnings per share				$ 0.15	$ 0.44
Morrisey Associates Inc [Member]
Business Acquisition [Line Items]
Total revenues	$ 2,581
Operating loss	$ (2,358)
Total revenues			$ 248,942	$ 236,205
Net income			$ 10,958	$ 6,610
Basic earnings per share			$ 0.34	$ 0.21
Diluted earnings per share			$ 0.34	$ 0.21

Property and Equipment - Summary of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 34,854	$ 30,772
Accumulated depreciation and amortization	(25,862)	(20,527)
Property and equipment, net	8,992	10,245
Equipment [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	25,396	20,885
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	5,291	5,025
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 4,167	$ 4,862

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Property, Plant and Equipment [Abstract]
Depreciation of property and equipment	$ 6.6	$ 6.8	$ 5.3

Goodwill - Changes in Carrying Amount of Goodwill (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Line Items]
Goodwill, beginning balance	$ 109,765	$ 83,073
Goodwill, ending balance	110,298	109,765
Morrisey Associates Inc [Member]
Goodwill [Line Items]
Goodwill acquired	533	20,467
Other Business Combination [Member]
Goodwill [Line Items]
Goodwill acquired		4,045
HealthLine Systems LLC [Member]
Goodwill [Line Items]
Goodwill acquired		2,180
Workforce Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	16,381	12,336
Goodwill, ending balance	16,381	16,381
Workforce Solutions [Member] \| Other Business Combination [Member]
Goodwill [Line Items]
Goodwill acquired		4,045
Patient Experience Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	24,154	24,154
Goodwill, ending balance	24,154	24,154
Provider Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	69,230	46,583
Goodwill, ending balance	69,763	69,230
Provider Solutions [Member] \| Morrisey Associates Inc [Member]
Goodwill [Line Items]
Goodwill acquired	$ 533	20,467
Provider Solutions [Member] \| HealthLine Systems LLC [Member]
Goodwill [Line Items]
Goodwill acquired		$ 2,180

Goodwill - Additional Information (Detail) $ in Thousands	3 Months Ended
Goodwill - Additional Information (Detail) $ in Thousands	Sep. 30, 2017 USD ($)
Morrisey Associates Inc [Member]
Goodwill [Line Items]
Adjustment to goodwill	$ 533

Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Finite-Lived Intangible Assets [Line Items]
Amortization of intangible assets	$ 9.5	$ 7.8	$ 5.6
Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	3 years
Minimum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	5 years
Minimum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	3 years
Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	13 years
Maximum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	13 years
Maximum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Estimated useful life of intangible assets	9 years

Intangible Assets - Identifiable Intangible Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Finite-Lived Intangible Assets [Line Items]
Gross Amount	$ 94,809	$ 94,809
Accumulated Amortization	(25,993)	(16,445)
Total	68,816	78,364
Customer Relationships [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Amount	77,985	77,985
Accumulated Amortization	(18,027)	(11,539)
Total	59,958	66,446
Other Intangible Assets [Member]
Finite-Lived Intangible Assets [Line Items]
Gross Amount	16,824	16,824
Accumulated Amortization	(7,966)	(4,906)
Total	$ 8,858	$ 11,918

Intangible Assets - Expected Annual Amortization Expense (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Goodwill and Intangible Assets Disclosure [Abstract]
2018	$ 9,438
2019	8,792
2020	8,139
2021	7,356
2022	6,277
Thereafter	28,814
Total	$ 68,816	$ 78,364

Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Revenues, net:
Revenues, net	$ 247,662	$ 225,974	$ 209,002
Operating income:
Operating income	9,800	5,567	13,557
Operating Segments [Member] \| Workforce Solutions [Member]
Revenues, net:
Revenues, net	178,061	168,040	161,289
Operating income:
Operating income	33,579	37,329	39,986
Operating Segments [Member] \| Patient Experience Solutions [Member]
Revenues, net:
Revenues, net	32,763	33,850	34,193
Operating income:
Operating income	1,491	(522)	1,548
Operating Segments [Member] \| Provider Solutions [Member]
Revenues, net:
Revenues, net	36,838	24,084	13,520
Operating income:
Operating income	879	(2,443)	(2,559)
Unallocated [Member]
Operating income:
Operating income	$ (26,149)	$ (28,797)	$ (25,418)

Business Segments - Business Segment Information Based on Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Segment Reporting Information [Line Items]
Total assets	$ 411,074	$ 396,000
Purchases of long-lived assets	18,033	14,550	$ 15,359
Depreciation and amortization	26,283	22,207	16,997
Operating Segments [Member] \| Workforce Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	90,055	96,323
Purchases of long-lived assets	9,888	9,266	11,403
Depreciation and amortization	9,982	8,243	6,693
Operating Segments [Member] \| Patient Experience Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	34,198	35,988
Purchases of long-lived assets	2,764	1,123	2,007
Depreciation and amortization	1,510	1,144	1,061
Operating Segments [Member] \| Provider Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	150,797	155,011
Purchases of long-lived assets	3,619	2,026	332
Depreciation and amortization	8,147	6,061	3,986
Unallocated [Member]
Segment Reporting Information [Line Items]
Total assets	136,024	108,678
Purchases of long-lived assets	1,762	2,135	1,617
Depreciation and amortization	$ 6,644	$ 6,759	$ 5,257

Income Taxes - Summary of Provision (Benefit) for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
Current federal	$ 1,679	$ (271)	$ 3,608
Current state	895	877	1,098
Deferred federal	(2,192)	1,489	501
Deferred state	147	298	(109)
Provision for income taxes	$ 529	$ 2,393	$ 5,098

Income Taxes - Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
Federal tax provision at the statutory rate	$ 3,687	$ 2,152	$ 4,802
State income tax provision, net of federal benefit	424	539	673
Tax credits	(583)	(560)	(425)
Change in state valuation allowance	322	308	(8)
Tax Act revaluation of deferred tax balances	(2,685)
Other	(636)	(46)	56
Provision for income taxes	$ 529	$ 2,393	$ 5,098

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Taxes Disclosure [Line Items]
Valuation allowance		$ 1,110,000	$ 654,000
Research and development tax credit carryforward expiration year		Dec. 31, 2037
Alternative minimum tax credit carryforward		$ 837,000
2017 Tax Act, reduction in deferred tax liability		2,685,000
Accrued interest and penalties		3,000	18,000
Unrecognized tax benefits		337,000	$ 350,000
Decrease in unrecognized tax benefits		$ 23,000
Scenario, Forecast [Member]
Income Taxes Disclosure [Line Items]
U.S. federal corporate income tax rate	21.00%
Earliest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years		Dec. 31, 2018
Latest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years		Dec. 31, 2027
Federal [Member] \| Earliest Tax Year [Member]
Income Taxes Disclosure [Line Items]
U.S. federal tax examinations for tax period		2015
Federal [Member] \| Latest Tax Year [Member]
Income Taxes Disclosure [Line Items]
U.S. federal tax examinations for tax period		2017
State [Member]
Income Taxes Disclosure [Line Items]
Net operating loss carryforwards		$ 19,500,000
Research and Development [Member]
Income Taxes Disclosure [Line Items]
Research and development tax credit carryforward		$ 2,300,000

Income Taxes - Reconciliation of the Beginning and Ending Liability for Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 397	$ 658
Additions for tax positions in the current year	10	64
Reductions for tax positions of prior years	(47)	(325)
Balance at end of year	$ 360	$ 397

Income Taxes - Significant Components of Deferred Tax Assets and Deferred Tax Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2017	Dec. 31, 2016
Deferred tax assets:
Allowance for doubtful accounts	$ 548	$ 332
Accrued liabilities	1,981	1,275
Tax credits	3,115	1,397
Stock based compensation	841	1,171
Deferred revenue	1,467	1,818
Depreciation	617	1,119
Basis difference on investments	327	316
Net operating loss carryforwards	1,015	743
Total deferred tax assets	9,911	8,171
Less: Valuation allowance	(1,110)	(654)
Deferred tax assets, net of valuation allowance	8,801	7,517
Deferred tax liabilities:
Deductible goodwill	2,917	3,267
Nondeductible intangible assets	1,330	2,523
Prepaid assets	1,881	1,894
Capitalized software development	4,599	5,801
Total deferred tax liabilities	10,727	13,485
Net deferred tax liabilities	$ (1,926)	$ (5,968)

Stock Based Compensation - Additional Information (Detail)	1 Months Ended	3 Months Ended	12 Months Ended
	Jun. 30, 2015 Employees shares	Jun. 30, 2015 USD ($) Employees shares	Dec. 31, 2017 USD ($) $ / shares shares	Dec. 31, 2016 USD ($) shares	Dec. 31, 2015 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unissued common stock reserved for future stock option grants \| shares			1.3
Closing stock price \| $ / shares			$ 23.16
Weighted average remaining contractual term of options, outstanding			10 months 25 days
Weighted average remaining contractual term of options, exercisable			10 months 25 days
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities			$ 412,000	$ 316,000	$ 756,000
Weighted average expense recognition period			2 years 6 months 21 days
Excess tax benefits related to stock based awards			$ 426,000
Stock based compensation expense			1,852,000	1,968,000	3,280,000
RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate fair value of RSU awards that vested			$ 1,900,000	$ 1,500,000
Shares withheld for RSUs \| shares			17,122	15,373
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities			$ 412,000	$ 316,000	230,000
Total unrecognized compensation expense related to non-vested stock options			$ 3,400,000
Restricted share units issued \| shares			111,000
Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of employees eligible to receive common stock \| Employees	600
Minimum eligible period of service required for the employees to receive common stock	1 year
Stock based compensation expense		$ 1,500,000
Common stock issued under stock plans, number of shares withheld \| shares		17,279
Total payments to taxing authorities for stock awards					$ 526,000
Chief Executive Officer [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of common stock contributed \| shares		54,241
Restricted share units issued \| shares		49,310
Number of employees eligible to receive common stock \| Employees		600
Stock based compensation expense		$ 1,500,000
Chief Executive Officer [Member] \| Stock Awards [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of common stock contributed \| shares	54,241
Restricted share units issued \| shares	49,310
Maximum [Member] \| RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of the options and RSU's granted			4 years
Maximum [Member] \| Stock Options [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Term of options granted			10 years

Stock Based Compensation - Summary of Activity and Various Other Information Relative to Stock Options (Detail) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($) $ / shares shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	476
Granted, Common Shares \| shares	0
Exercised, Common Shares \| shares	(100)
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	376
Exercisable at end of period, Common Shares \| shares	376
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 6.74
Granted, Weighted-Average Exercise Price \| $ / shares	0
Exercised, Weighted-Average Exercise Price \| $ / shares	4.13
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	7.44
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 7.44
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 5,912
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 5,912

Stock Based Compensation - Other Information Relative to Option Activity (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Total grant date fair value of stock options vested			$ 232
Total intrinsic value of stock options exercised	$ 1,973	$ 820	1,662
Cash proceeds from exercise of stock options	$ 413	$ 145	$ 328

Stock Based Compensation - Summary of Activity Relative to RSU's (Detail) - RSUs [Member] $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding at beginning of period, shares \| shares	253
Granted \| shares	111
Vested \| shares	(77)
Forfeited \| shares	(28)
Outstanding at end of period, shares \| shares	259
Outstanding at beginning of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 23.36
Granted, Weighted-Average Grant Date Fair Value \| $ / shares	23.43
Vested, Weighted-Average Grant Date Fair Value \| $ / shares	24.21
Forfeited, Weighted-Average Grant Date Fair Value \| $ / shares	23.39
Outstanding at end of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 23.13
Aggregate intrinsic Value \| $	$ 6,002

Stock Based Compensation - Stock Based Compensation Expense Recorded in Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 1,852	$ 1,968	$ 3,280
Cost of Revenues (Excluding Depreciation and Amortization) [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	76	144	824
Product Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	258	178	569
Sales and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	240	239	547
Other General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 1,278	$ 1,407	$ 1,340

Employee Benefit Plan - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Schedule Of Sale Of Subsidiary [Abstract]
Employees minimum age eligibility to participate in plan	21 years
Minimum number of days required to be eligible for participation in plan	30 days
Defined contribution plan, employer matching contribution amount	$ 909,000	$ 391,000	$ 645,000

Debt - Additional Information (Detail) - USD ($)	12 Months Ended
Debt - Additional Information (Detail) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Line of Credit Facility [Line Items]
Debt outstanding	$ 0	$ 0
SunTrust Bank [Member]
Line of Credit Facility [Line Items]
Description of Line of credit facility Covenant	A funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not greater than 3.0 to 1.0 and an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not less than 3.0 to 1.0.
SunTrust Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.30%
SunTrust Bank [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.20%
Revolving Credit Facility [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Interest coverage ratio	300.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member]
Line of Credit Facility [Line Items]
Maturity date of Loan agreement	Nov. 24, 2018
Maximum borrowing capacity under credit facility	$ 50,000,000
Increase in revolving credit facility	$ 25,000,000
Interest rate under credit facility	The borrowings under the Revolving Credit Facility bear interest at either (1) a rate per annum equal to the highest of SunTrust’s prime rate or 0.5% in excess of the Federal Funds Rate or 1.0% in excess of one-month LIBOR (the “Base Rate”), plus an applicable margin, or (2) the one, two, three, or six-month per annum LIBOR for deposits in the applicable currency (the “Eurocurrency Rate”), as selected by the Company, plus an applicable margin. The applicable margin for Eurocurrency Rate loans depends on the Company’s funded debt leverage ratio and varies from 1.50% to 2.00%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 1.50%.
Principal payments prior to maturity	$ 0
Outstanding and borrowing balance on the revolving credit facility	0
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Swing Line Sub Facility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	5,000,000
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Letter of Credit Subfacility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	$ 5,000,000
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Federal Funds Effective Swap Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	0.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	1.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Maximum total leverage ratio	300.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Maximum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	2.00%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Minimum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	0.50%
Revolving Credit Facility [Member] \| SunTrust Bank [Member] \| Minimum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%

Leases - Additional Information (Detail) - USD ($)	12 Months Ended
Leases - Additional Information (Detail) - USD ($)	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2018
Operating Leases Disclosure [Line Items]
Total rent expense under all operating leases	$ 7,600,000	$ 5,600,000	$ 4,300,000
Scenario, Forecast [Member]
Operating Leases Disclosure [Line Items]
Future minimum rental payments				$ 148,000

Leases - Future Rental Payment Commitments under Non-Cancelable Operating Leases (Detail) $ in Thousands	Dec. 31, 2017 USD ($)
Leases [Abstract]
2018	$ 4,720
2019	3,495
2020	3,920
2021	3,750
2022	3,744
Thereafter	20,361
Total minimum lease payments	$ 39,990

Collaborative Arrangement - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Collaborative arrangement profit/loss sharing percentage	50.00%
Expenses related to collaborative arrangement	$ 1.2	$ 1.4	$ 1.8
Collaborative Arrangement, Product [Member]
Collaborative Arrangements and Non-collaborative Arrangement Transactions [Line Items]
Collaborative arrangement revenues	$ 2.2	$ 2.7	$ 2.2

Related Party Transactions - Additional Information (Detail) $ in Thousands	3 Months Ended	12 Months Ended
	Jun. 30, 2015 USD ($) Employees shares	Dec. 31, 2017 USD ($)	Dec. 31, 2016 USD ($)	Dec. 31, 2015 USD ($)
Related Party Transaction [Line Items]
Stock based compensation expense \| $		$ 1,852	$ 1,968	$ 3,280
Chief Executive Officer [Member]
Related Party Transaction [Line Items]
Number of common stock contributed	54,241
Restricted share units issued	49,310
Number of employees eligible to receive common stock \| Employees	600
Stock based compensation expense \| $	$ 1,500
Common stock unissued shares treated as expense	4,931

Subsequent Events - Additional Information (Detail) - Subsequent Event [Member] - USD ($)		3 Months Ended
	Feb. 12, 2018	Mar. 31, 2018
Subsequent Event [Line Items]
Special cash dividend		$ 1.00
Dividend payable date		Apr. 03, 2018
Dividend record date		Mar. 06, 2018
Minimum [Member]
Subsequent Event [Line Items]
Pre-tax gain on sale of business		$ 34,000,000
Maximum [Member]
Subsequent Event [Line Items]
Pre-tax gain on sale of business		$ 38,000,000
Patient Experience Solutions [Member]
Subsequent Event [Line Items]
Consideration received	$ 65,500,000
Consideration held in escrow	$ 6,500,000

Stock Based Compensation - Summary of Activity and Various Other Information Relative to Stock Options (Detail) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2017 USD ($) $ / shares shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	476
Granted, Common Shares \| shares	0
Exercised, Common Shares \| shares	(100)
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	376
Exercisable at end of period, Common Shares \| shares	376
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 6.74
Granted, Weighted-Average Exercise Price \| $ / shares	0
Exercised, Weighted-Average Exercise Price \| $ / shares	4.13
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	7.44
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 7.44
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 5,912
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 5,912