0001564590-21-008985 | 10-K | XBRL Viewer

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Document and Entity Information - USD ($) $ in Millions	12 Months Ended
Document and Entity Information - USD ($) $ in Millions	Dec. 31, 2020	Feb. 22, 2021	Jun. 30, 2020
Cover [Abstract]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2020
Document Fiscal Year Focus	2020
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 Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Common Stock, Shares Outstanding		31,493,677
Entity Public Float			$ 565.2
Entity Shell Company	false
Entity File Number	000-27701
Entity Tax Identification Number	62-1443555
Entity Address, Address Line One	500 11th Avenue North
Entity Address, Address Line Two	Suite 1000
Entity Address, City or Town	Nashville
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37203
City Area Code	615
Local Phone Number	301-3100
Entity Interactive Data Current	Yes
Entity Incorporation, State or Country Code	TN
Document Annual Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock (Par Value $0.00)
Security Exchange Name	NASDAQ
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE Portions of the Registrant’s definitive Proxy Statement for its 2021 Annual Meeting of Shareholders are incorporated by reference into Part III hereof.

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Current assets:
Cash and cash equivalents	$ 36,566	$ 131,538
Marketable securities	9,928	41,328
Accounts receivable, net of allowance for doubtful accounts of $549 and $843 at December 31, 2020 and 2019, respectively	40,726	27,650
Accounts receivable - unbilled	5,374	2,726
Prepaid royalties, net of amortization	9,571	11,898
Other prepaid expenses and other current assets	12,560	9,432
Total current assets	114,725	224,572
Property and equipment, net of accumulated depreciation of $19,237 and $19,291 at December 31, 2020 and 2019, respectively	22,218	26,065
Capitalized software development, net of accumulated amortization of $70,516 and $57,768 at December 31, 2020 and 2019, respectively	26,631	21,445
Operating lease right of use assets, net	28,081	29,615
Goodwill	178,440	102,196
Intangible assets, net	100,715	60,081
Deferred tax assets	974	269
Deferred commissions	19,907	17,645
Non-marketable equity investments	6,845	6,782
Other assets	1,777	874
Total assets	500,313	489,544
Current liabilities:
Accounts payable	9,333	4,810
Accrued royalties	8,809	16,736
Accrued liabilities	20,124	18,128
Deferred revenue	81,176	65,511
Total current liabilities	119,442	105,185
Deferred tax liabilities	14,523	13,183
Deferred revenue, non-current	1,603	1,918
Operating lease liability, non-current	28,479	30,733
Other long-term liabilities	2,204	357
Commitments and contingencies
Shareholders’ equity:
Common stock, no par value, 75,000 shares authorized; 31,493 and 32,379 shares issued and outstanding at December 31, 2020 and 2019, respectively	271,784	290,021
Retained earnings	62,277	48,143
Accumulated other comprehensive income	1	4
Total shareholders’ equity	334,062	338,168
Total liabilities and shareholders’ equity	500,313	489,544
Customer-Related Intangible Assets [Member]
Current assets:
Intangible assets, net	76,927	52,554
Other Intangible Assets [Member]
Current assets:
Intangible assets, net	$ 23,788	$ 7,527

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Allowance for doubtful accounts, net	$ 549	$ 843
Accumulated depreciation on property and equipment	19,237	19,291
Accumulated amortization on capitalized software development	70,516	57,768
Accumulated amortization on intangible assets	$ 47,471	$ 42,495
Common stock, no par value
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	31,493,000	32,379,000
Common stock, shares outstanding	31,493,000	32,379,000
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 36,723	$ 29,760
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 10,748	$ 12,735

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Statement [Abstract]
Revenues, net	$ 244,826	$ 254,112	$ 231,616
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	89,332	103,890	96,014
Product development	32,305	29,109	25,735
Sales and marketing	35,297	37,945	35,698
Other general and administrative expenses	41,885	40,579	34,447
Depreciation and amortization	30,189	27,869	24,231
Total operating costs and expenses	229,008	239,392	216,125
Operating income	15,818	14,720	15,491
Other income, net	2,005	3,209	1,084
Income from continuing operations before income tax provision	17,823	17,929	16,575
Income tax provision	3,732	3,733	3,324
Income from continuing operations	14,091	14,196	13,251
Loss from discontinued operations before income tax provision			(64)
Gain on sale of discontinued operations		2,053	29,489
Income tax provision		479	10,459
Income from discontinued operations		1,574	18,966
Net income	$ 14,091	$ 15,770	$ 32,217
Net income per share – basic:
Continuing operations	$ 0.44	$ 0.44	$ 0.41
Discontinued operations		0.05	0.59
Net income per share - basic	0.44	0.49	1.00
Net income per share - diluted:
Continuing operations	0.44	0.44	0.41
Discontinued operations		0.05	0.59
Net income per share - diluted	$ 0.44	$ 0.49	$ 1.00
Weighted average shares of common stock outstanding:
Basic	31,960	32,372	32,264
Diluted	31,989	32,428	32,335
Dividends declared per share			$ 1.00

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Statement Of Income And Comprehensive Income [Abstract]
Net income	$ 14,091	$ 15,770	$ 32,217
Other comprehensive income, net of taxes:
Foreign currency translation adjustments	6	2
Unrealized (loss) gain on marketable securities	(9)	25	15
Total other comprehensive income	(3)	27	15
Comprehensive income	$ 14,088	$ 15,797	$ 32,232

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Consolidated Statements of Shareholders' Equity - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment [Member]	Common Stock [Member]	Retained Earnings [Member]	Retained Earnings [Member] Cumulative Effect, Period of Adoption, Adjustment [Member]	Accumulated Other Comprehensive (Loss)/Income [Member]
Beginning balance at Dec. 31, 2017	$ 300,170	$ 15,132	$ 282,666	$ 17,542	$ 15,132	$ (38)
Beginning balance, shares at Dec. 31, 2017			31,908,000
Net income	32,217			32,217
Comprehensive income	15					15
Dividends declared on common stock ($1.00 per share)	(32,518)			(32,518)
Stock based compensation	1,686		$ 1,686
Common stock issued under stock plans, net of shares withheld for employee taxes	2,245		$ 2,245
Common stock issued under stock plans, net of shares withheld for employee taxes, shares			417,000
Ending balance at Dec. 31, 2018	318,947		$ 286,597	32,373		(23)
Ending balance, shares at Dec. 31, 2018			32,325,000
Net income	15,770			15,770
Comprehensive income	27					27
Stock donated to Company (held in treasury), shares			(86,000)
Stock based compensation	4,244		$ 4,244
Common stock issued under stock plans, net of shares withheld for employee taxes	(820)		$ (820)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares			140,000
Ending balance at Dec. 31, 2019	$ 338,168		$ 290,021	48,143		4
Ending balance, shares at Dec. 31, 2019	32,379,000		32,379,000
Net income	$ 14,091			14,091
Dividend forfeitures on unvested equity awards	43			43
Comprehensive income	(3)					(3)
Stock based compensation	2,217		$ 2,217
Common stock issued under stock plans, net of shares withheld for employee taxes	(435)		$ (435)
Common stock issued under stock plans, net of shares withheld for employee taxes, shares			71,000
Repurchase of common stock	$ (20,019)		$ (20,019)
Repurchase of common stock, shares	(957,367)		(957,000)
Ending balance at Dec. 31, 2020	$ 334,062		$ 271,784	$ 62,277		$ 1
Ending balance, shares at Dec. 31, 2020	31,493,000		31,493,000

Consolidated Statements of Shareholders' Equity (Parenthetical)	12 Months Ended
	Dec. 31, 2018 $ / shares
Statement Of Stockholders Equity [Abstract]
Dividends per share common stock	$ 1.00

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
OPERATING ACTIVITIES:
Net income	$ 14,091	$ 15,770	$ 32,217
Income from discontinued operations		(1,574)	(18,966)
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	30,189	27,869	24,231
Stock based compensation	2,217	4,244	1,777
Amortization of deferred commissions	8,768	8,305	7,659
Provision for doubtful accounts	274	211	1,033
Deferred income taxes	4,295	2,167	3,017
Loss (gain) on equity method investments	51	(64)	(42)
Non-cash royalty expense	(3,440)
Change in fair value of non-marketable equity investments	(1,181)		1,271
Other	347	(72)	(9)
Changes in operating assets and liabilities:
Accounts and unbilled receivables	(2,992)	11,605	(4,050)
Prepaid royalties	2,397	1,698	1,639
Other prepaid expenses and other current assets	(2,985)	4,862	(3,938)
Deferred commissions	(11,030)	(9,479)	(11,577)
Other assets	(112)	(42)	(30)
Accounts payable and accrued expenses	1,124	1,098	2,008
Accrued royalties	(4,672)	979	2,907
Deferred revenue	(1,467)	(1,920)	5,103
Net cash provided by operating activities	35,874	65,657	44,250
Net cash used in discontinued operating activities			(1,004)
Net cash provided by operating activities	35,874	65,657	43,246
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(121,342)	(27,018)
Proceeds from sale of discontinued operations, net of tax		6,070	44,049
Proceeds from maturities of marketable securities	77,120	80,589	68,992
Proceeds from sales of marketable securities	15,051
Purchases of marketable securities	(61,179)	(87,328)	(57,085)
Proceeds from sale of property and equipment		15
Payments to acquire non-marketable equity investments	(1,257)	(3,342)	(833)
Payments associated with capitalized software development	(16,815)	(14,513)	(11,284)
Purchases of property and equipment	(1,988)	(21,997)	(7,166)
Net cash (used in) provided by continuing investing activities	(110,410)	(67,524)	36,673
Net cash used in discontinued investing activities			(115)
Net cash (used in) provided by investing activities	(110,410)	(67,524)	36,558
FINANCING ACTIVITIES:
Proceeds from exercise of stock options		214	2,582
Taxes paid related to net settlement of equity awards	(435)	(1,034)	(338)
Payment of earn-out related to prior acquisitions		(38)	(38)
Payment of debt issue cost			(100)
Repurchases of common stock	(20,019)
Payment of cash dividends	(40)	(58)	(32,357)
Net cash used in financing activities	(20,494)	(916)	(30,251)
Effect of exchange rate changes on cash and cash equivalents	58
Net (decrease) increase in cash and cash equivalents	(94,972)	(2,783)	49,553
Cash and cash equivalents at beginning of period	131,538	134,321	84,768
Cash and cash equivalents at end of period	36,566	131,538	134,321
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid	96	101	117
Income taxes paid	877	630	16,513
Non-cash additions to property and equipment		$ 31	$ 1,013
Non-cash additions to non-marketable equity investments	$ 1,300

Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

1. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Description of Business

HealthStream, Inc. (the Company) was incorporated in 1990 as a Tennessee corporation and is headquartered in Nashville, Tennessee. As of December 31, 2020, the Company operated in two segments: Workforce Solutions and Provider Solutions. Workforce Solutions products help meet the ongoing training, certification, assessment, development, and scheduling needs of the healthcare workforce; they are primarily delivered via a software-as-a-service (SaaS) model and are sold on a subscription basis. Provider Solutions products offer healthcare organizations software applications for administering and tracking provider credentialing, privileging, call center, and enrollment activities.

On February 12, 2018, the Company divested its Patient Experience (PX) business to Press Ganey Associates (Press Ganey) for $65.2 million in cash (after giving effect to the post-closing working capital adjustment). This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The results of operations for PX are presented as discontinued operations within the Notes to Consolidated Financial Statements herein.

Recently Adopted Accounting Standards

In June 2016, the Financial Accounting Standards board (FASB) issued Accounting Standards Update (ASU) 2016-03, Financial Instruments—Credit Losses (ASU 326): Measurement of Credit Losses on Financial Instruments, which amends the impairment model by requiring entities to use a forward-looking approach, based on expected losses, to estimate credit losses on certain types of financial instruments, including trade accounts receivables. The Company adopted this ASU on January 1, 2020, and the effect of adoption on the Company’s Consolidated Financial Statements and related disclosures was not material.

Recognition of Revenue

Revenues are recognized when control of the promised goods or services is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled in exchange for transferring those goods or services. The Company adopted ASU 2014-09, Revenue from Contracts with Customer (referred to as Accounting Standards Codification (ASC) Topic 606 or ASC 606) effective as of January 1, 2018 utilizing the modified retrospective approach. This accounting standard required changes to the Company’s accounting policies for revenue recognition, trade and other receivables, and deferred commissions.

Revenue is recognized based on the following five step model:

•

Identification of the contract with a customer

•

Identification of the performance obligations in the contract

•

Determination of the transaction price

•

Allocation of the transaction price to the performance obligations in the contract

•

Recognition of revenue when, or as, the Company satisfies a performance obligation

Subscription revenues primarily consist of fees in consideration of providing customers access to one or more of our SaaS-based solutions and/or courseware subscriptions, as well as fees related to licensing agreements, all of which include routine customer support and technology enhancements. Revenue is generally recognized over time during the contract term beginning when the service is made available to the customer. Subscription contracts are generally non-cancelable, one to five years in length, and billed annually, semi-annually, quarterly, or monthly in advance.

Professional services revenues primarily consist of fees for implementation services, consulting, custom courseware development, and training. The majority of our professional services contracts are billed in advance based on a fixed price basis, and revenue is recognized over time as the services are performed. For both subscription services and professional services, the time between billing the customer and when performance obligations are satisfied is generally not significant.

Our contracts with customers often contain promises for multiple goods and services. For these contracts, the Company accounts for the promised goods and services in its contracts as separate performance obligations if they are distinct. The contract price, which represents transaction price when the contract reflects a fixed fee arrangement, or management’s estimate of variable consideration including application of the constraint when the contract does not have a fixed fee, is allocated to the separate performance obligations on a relative standalone selling price basis. We generally determine standalone selling prices based on the standard list price for each product, taking into consideration certain factors, including contract length and the number of subscriptions or users within the contract.

We receive payments from customers based on billing schedules established in our contracts. Accounts receivable - unbilled represent contract assets related to our conditional right to consideration for subscription and professional services contracts where performance has occurred under the contract. Accounts receivable are primarily comprised of trade receivables that are recorded at the invoice amount, net of an allowance for doubtful accounts, when the right to consideration becomes unconditional.

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Basis of Presentation

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 United States 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 other income, net 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, net 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.

Deferred Commissions

Deferred commissions represent incremental costs to acquire contracts with customers, such as the initial sales commission payment and associated payroll taxes, which are capitalized and amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit. Capitalized contract costs are included under the caption deferred commissions in the accompanying Consolidated Balance Sheet. The expected period of benefit is the contract term, except when the capitalized commission 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. Non-commensurate commissions are amortized over the greater of the contract term or technological obsolescence period of three years.

Prepaid Royalties

Prepaid royalties represent advance payments to royalty partners under revenue sharing arrangements for which the Company sells and delivers such partner products to its customers. Royalties are typically paid in advance at the commencement of the subscription period or periodically throughout the subscription period, such as in quarterly, bi-annual, or annual installments. Royalty payments are amortized over the term of the underlying subscription contracts, which generally range from one to five years, 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 based on its historical collection experience, a review in each period of the status of the then-outstanding accounts receivable, and external market factors. Uncollectible receivables are written-off in the period management believes it has exhausted its ability to collect payment from the customer. Bad debt expense is recorded when events or circumstances indicate an additional allowance is required.

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
2020	$	843	$	274	$	(568	)	$	549
2019		1,161		211		(529	)		843
2018		1,979		1,033		(1,851	)		1,161

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 $17.9 million and $14.1 million during 2020 and 2019, respectively. Amortization of capitalized software development was $12.7 million, $11.0 million, and $9.6 million during 2020, 2019, and 2018, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2020 and 2019, 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, 2020 and 2019, 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).

Property and Equipment

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

	Years
Furniture and fixtures	5 - 7
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, including intangible assets. The Company estimates fair values of intangible assets using the income and cost methods, which are based on management’s estimates and assumptions. 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, 2020, 2019, or 2018.

As of December 31, 2020, intangible assets include customer relationships, internally developed technology, non-competition agreements, and trade names. Intangible assets that are considered to have definite useful lives are being amortized on a straight-line basis over periods ranging between three and eighteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2020 was 11.4 years. Intangible assets considered to have indefinite useful lives are evaluated for impairment at least annually during the fourth quarter, and all 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, 2020, 2019, or 2018.

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, deferred commissions, and other assets will be recoverable. There were no long-lived asset impairments identified or recorded for the years ended December 31, 2020, 2019, or 2018.

Non-Marketable Equity Investments

Non-marketable equity investments in limited liability companies with specific ownership accounts for each investor not resulting in a controlling financial interest are accounted for using the equity method of accounting. Non-marketable equity investments of preferred stock in corporations that do not result in a controlling financial interest are accounted for using the measurement alternative for equity investments that do not have readily determinable fair values. ASU 2016-01, Financial Instruments – Overall (Subtopic 825-10) requires 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 fair value of non-marketable equity investments is not estimated if there are no identified events or changes in circumstances that may have a significant adverse effect on the fair value of the investment. The proportionate share of income or loss from equity method investments and any changes in fair value of investments accounted for using the measurement alternative 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, 2020, 2019, and 2018 was $1.1 million, $0.8 million, and $0.7 million, respectively, and is included under the caption sales and marketing expense in the accompanying Consolidated Statements of Income.

Shipping and Handling Costs

Shipping and handling costs that are associated with our products and services are included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

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, 2020, the Company had established a valuation allowance of $0.6 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.

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 were excluded from the calculation of diluted weighted average shares outstanding for the years ended December 31, 2020, 2019, and 2018.

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 government sponsored enterprise debt securities.

The Company sells its products and services to various companies in the healthcare industry that are primarily located in the United States. Customer credit worthiness evaluations are performed on an as-needed basis, and the Company generally requires 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 2020, 2019, or 2018.

Stock Based Compensation

As of December 31, 2020, the Company maintained one stock based compensation plan 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 Consolidated Statements of Income as a component of the provision for income taxes when realized.

Leases

The Company has various non-cancelable agreements to lease office space. Effective January 1, 2019, the Company adopted ASC 842, which requires an entity to recognize a right-of-use (ROU) asset and a lease liability on the balance sheet for substantially all leases, including operating leases, using the modified retrospective approach. The Company elected to use the package of practicable expedients allowing companies to not reassess: (1) the lease classification for any expired or existing leases, (2) the treatment of initial direct costs as they related to existing leases, and (3) whether existing contracts are or contain leases. The Company did not elect the use of the hindsight practical expedient but did elect the practical expedient not to separate lease components from non-lease components related to its office space leases.

The Company does not have any lease contracts that contain: (1) an option to extend that the Company is reasonably certain to exercise, (2) an option to terminate that the Company is reasonably certain not to exercise, or (3) an option to extend (or not to terminate) in which exercise of the option is controlled by the lessor. Additionally, the Company does not have any leases with residual value guarantees or material restrictive covenants. For leases already commenced, the lease term was determined to be the remaining months in the lease term as of January 1, 2019, the date of adoption, or for current year acquisitions, the date of acquisition. The Company has elected not to recognize leases with initial terms of one year or less on the balance sheet. Lease liabilities and their corresponding right-of-use assets have been recorded based on the present value of the future lease payments over the expected lease term. Most of the Company’s lease agreements contain provisions for escalating rent payments over the terms of the leases, which escalations are either fixed within the contract or are variable based on the consumer price index.

The Company’s leases do not contain readily determinable implicit discount rates, and as such the Company must use its incremental borrowing rate to discount the future lease payments based on information available at lease commencement. The incremental borrowing rate was estimated by determining the rate of interest that the Company would have to pay to borrow on a collateralized basis over a similar term an amount equal to the lease payments in a similar economic environment.

Foreign Currency

The functional currency for the Company’s subsidiaries is determined based on the primary economic environment in which the subsidiary operates. The Company translates the assets and liabilities of its non-U.S. dollar functional currency subsidiaries into U.S. dollars using exchange rates in effect at the end of each period. Revenues and expenses for these subsidiaries are translated using rates that approximate those in effect during the period. Gains and losses from these translations are recognized as cumulative translation adjustment included in accumulated other comprehensive income in the Consolidated Balance Sheets.

Shareholders' Equity

12 Months Ended

Dec. 31, 2020

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, 2020 and 2019 was 31.5 million and 32.4 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.

Share Repurchase Plan

On March 13, 2020, the Company’s Board of Directors authorized a share repurchase program to repurchase up to $30.0 million of outstanding shares of common stock. The share repurchase program will terminate on the earlier of March 12, 2021 or when the maximum dollar amount has been expended. Pursuant to this authorization, repurchases have been made, and may continue to be made from time to time, in the open market through privately negotiated transactions or otherwise, including under a Rule 10b5-1 plan, which permits shares to be repurchased when the Company might otherwise be precluded from doing so under insider trading laws in accordance with specific prearranged terms related to timing, price, and volume (among others), without further direction from the Company. The share repurchase program does not require the Company to acquire any amount of shares and may be suspended or discontinued at any time. During the year ended December 31, 2020, the Company repurchased 957,367 shares at an aggregate fair value of $20.0 million, based on an average price per share of $20.89 (excluding the cost of broker commissions).

Earnings Per Share

12 Months Ended

Dec. 31, 2020

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, 2020 (in thousands, except per share amounts):

	Year Ended December 31,
	2020		2019		2018
Numerator:
Income from continuing operations	$	14,091	$	14,196	$	13,251
Income from discontinued operations		—		1,574		18,966
Net income	$	14,091	$	15,770	$	32,217
Denominator:
Weighted-average shares outstanding		31,960		32,372		32,264
Effect of dilutive shares		29		56		71
Weighted-average diluted shares		31,989		32,428		32,335

Net income per share – basic:
Continuing operations	$	0.44	$	0.44	$	0.41
Discontinued operations		—		0.05		0.59
Net income per share - basic	$	0.44	$	0.49	$	1.00

Net income per share – diluted:
Continuing operations	$	0.44	$	0.44	$	0.41
Discontinued operations		—		0.05		0.59
Net income per share - diluted	$	0.44	$	0.49	$	1.00

Potentially dilutive shares representing 122,000, 93,000, and 91,000 shares of common stock for the years ended December 31, 2020, 2019, and 2018, 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, 2020

Investments Debt And Equity Securities [Abstract]

Marketable Securities

4. MARKETABLE SECURITIES

At December 31, 2020 and 2019, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	December 31, 2020
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value		Cash and Cash Equivalents		Current Marketable Securities
Cash	$	31,558	$	—	$	—		$	31,558	$	31,558	$	—
Level 2:
Time deposits		10,021		—		—			10,021		5,008		5,013
Corporate debt securities		4,923		—		(8	)		4,915		—		4,915
Total	$	46,502	$	—	$	(8	)	$	46,494	$	36,566	$	9,928

	December 31, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value		Cash and Cash Equivalents		Current Marketable Securities
Cash	$	131,538	$	—	$	—		$	131,538	$	131,538	$	—
Level 2:
Corporate debt securities		37,325		7		(5	)		37,327		—		37,327
Government-sponsored enterprise debt securities		4,001		—		—			4,001		—		4,001
Total	$	172,864		7		(5	)	$	172,866	$	131,538	$	41,328

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, 2020, the Company does not consider any of its marketable securities to be other than temporarily impaired. During the years ended December 31, 2020 and 2019, 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 Consolidated Balance Sheet because the underlying securities mature within one year from the balance sheet date.

Revenue Recognition and Sales Commissions

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Revenue Recognition and Sales Commissions

5. REVENUE RECOGNITION AND SALES COMMISSIONS

Revenue Recognition

The following table represents revenues included in continuing operations disaggregated by revenue source for the years ended December 31, 2020, 2019, and 2018 (in thousands). Sales taxes are excluded from revenues.

	Year Ended December 31, 2020
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	193,673	$	40,237	$	233,910
Professional services		3,914		7,002		10,916
Total revenues, net	$	197,587	$	47,239	$	244,826

	Year Ended December 31, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

	Year Ended December 31, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	184,926	$	35,542	$	220,468
Professional services		5,213		5,935		11,148
Total revenues, net	$	190,139	$	41,477	$	231,616

For the years ended December 31, 2020 and 2019, the Company recognized $0.3 million and $0.2 million, respectively, in impairment losses on receivables and contract assets arising from the Company’s contracts with customers.

During the years ended December 31, 2020, 2019, and 2018, we recognized revenues of $64.5 million, $64.7 million, and $63.7 million from amounts included in deferred revenue at the beginning of the respective period. As of December 31, 2020, $464 million of revenue is expected to be recognized from remaining performance obligations under contracts with customers. We expect to recognize revenue on approximately 47% of these remaining performance obligations over the 12 months ending December 31, 2020, with the remaining amounts recognized thereafter.

Sales Commissions

Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer. Under ASC 606, costs to acquire contracts with customers, such as the initial sales commission payment and associated payroll taxes, are capitalized in the period a customer contract is entered into and are amortized consistent with the transfer of the goods or services to the customer over the expected period of benefit, whereas subsequent sales commission payments which require a substantive performance condition of the employee are expensed ratably through the payment date. Capitalized contract costs are included in deferred commissions in the accompanying Condensed Consolidated Balance Sheets. The expected period of benefit is the contract term, except when the capitalized commission 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. Non-commensurate commissions are amortized over the greater of the contract term or technological obsolescence period of approximately three years. The Company recorded amortization of deferred commissions of $8.8 million, $8.3 million, and $7.7 million for the years ended December 31, 2020, 2019 and 2018, which is included in sales and marketing expenses in the accompanying Consolidated Statements of Income.

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-URI http://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 10
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130551-203045

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130556-203045

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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-Section 50
-Paragraph 12
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Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Subparagraph (e)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (d)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 15
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130558-203045

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 12
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=121604090&loc=SL49130554-203045

+ Details

Property and Equipment

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Property and Equipment

6. PROPERTY AND EQUIPMENT

Property and equipment consist of the following (in thousands):

	December 31,
	2020			2019
Equipment	$	21,401		$	25,199
Leasehold improvements		14,980			14,909
Furniture and fixtures		5,074			5,248
Gross property and equipment		41,455			45,356
Accumulated depreciation and amortization		(19,237	)		(19,291	)
Property and equipment, net	$	22,218		$	26,065

Depreciation of property and equipment totaled $6.9 million, $7.3 million, and $5.5 million for the years ended December 31, 2020, 2019, and 2018, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2020

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

7. GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2020 and 2019 are as follows (in thousands):

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2020	$	27,776	$	74,420	$	102,196
Acquisition of NurseGrid		21,085		—		21,085
Acquisition of ShiftWizard		19,307		—		19,307
Acquisition of ANSOS		35,258		—		35,258
Acquisition of myClinicalExchange		590		—		590
Post-closing adjustment for CredentialMyDoc		—		4		4
Balance at December 31, 2020	$	104,016	$	74,424	$	178,440

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2019	$	16,381	$	69,763	$	86,144
Acquisition of Providigm, LLC		11,395		—		11,395
Acquisition of CredentialMyDoc		—		4,657		4,657
Balance at December 31, 2019	$	27,776	$	74,420	$	102,196

Intangible assets other than goodwill that are considered to have finite useful lives include customer-related intangibles consisting of customer relationships, which are amortized over their estimated useful lives ranging from five to eighteen years, and other intangible assets consisting of technology, non-competition agreements, and trade names, which are amortized over their estimated useful lives ranging from one to nine years. The Company also recorded an indefinite lived intangible for a trade name valued at $0.7 million. Amortization of intangible assets was $10.5 million, $9.6 million, and $9.1 million for the years ended December 31, 2020, 2019, and 2018, respectively.

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

	As of December 31, 2020							As of December 31, 2019
	Gross Amount		Accumulated Amortization			Net		Gross Amount		Accumulated Amortization			Net
Customer related	$	113,650	$	(36,723	)	$	76,927	$	82,314	$	(29,760	)	$	52,554
Other		34,536		(10,748	)		23,788		20,262		(12,735	)		7,527
Total	$	148,186	$	(47,471	)	$	100,715	$	102,576	$	(42,495	)	$	60,081

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

2021	$	14,723
2022		13,599
2023		12,937
2024		11,440
2025		10,724
Thereafter		36,593
Total	$	100,016

Business Combinations

12 Months Ended

Dec. 31, 2020

Business Combinations [Abstract]

Business Combinations

8. BUSINESS COMBINATIONS

NurseGrid

On March 9, 2020, the Company acquired all of the outstanding stock of HcT2 Co. dba NurseGrid (NurseGrid), a Portland, Oregon-based healthcare technology company offering NurseGrid Mobile and its corollary application for nurse managers, NurseGrid Enterprise, for net cash consideration of approximately $21.5 million, after giving effect to the post-closing working capital adjustment. The Company accounted for this transaction as a business combination achieved in stages which required the Company to remeasure its previously existing minority ownership interest held in NurseGrid, which was accounted for as a non-marketable equity investment measured using the fair value alternative, to fair value at the acquisition date based on the total enterprise value, adjusting for a control premium. The fair value of the Company’s interest in NurseGrid was $3.6 million at closing, resulting in a gain of $1.2 million, recorded as a change in fair value of non-marketable equity investments in the Company’s Condensed Consolidated Statements of Income. Additionally, the Company’s previously recorded non-marketable equity investment in NurseGrid was de-recognized from the Company’s Condensed Consolidated Balance Sheet. Acquisition-related transaction costs were $0.2 million. The financial results of NurseGrid have been included in the Workforce Solutions segment from March 9, 2020.

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

Cash paid at closing	$	25,485
Post-closing adjustment, net of cash received		33
Cash acquired		(4,064	)
Net consideration paid		21,454
Fair value of existing equity interest in NurseGrid		3,623
Net consideration paid	$	25,077

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

Accounts and unbilled receivable, net	$	92
Prepaid and other current assets		155
Operating lease right-of-use assets		50
Deferred tax assets		2,121
Goodwill		21,085
Intangible assets		1,845
Accounts payable and accrued liabilities		(143	)
Deferred revenue		(78	)
Operating lease liabilities		(50	)
Net assets acquired	$	25,077

user community, and expected synergies from integrating NurseGrid with other combined functional areas within the Company. The goodwill balance is not 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 $157,000 to an estimated fair value of $78,000. The $79,000 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	$	35	8 years
Developed technology		1,110	5 years
Trade name		700	Indefinite
Total intangible assets	$	1,845

The amounts of revenue and operating loss of NurseGrid included in the Company’s Consolidated Statement of Income since the date of acquisition of March 9, 2020 for the year ended December 31, 2020 are as follows (in thousands):

Total revenues		$	219
Operating loss		$	(2,650	)

The following unaudited pro forma financial information summarizes the results of operations of the Company and NurseGrid as though the companies were combined as of January 1, 2019 (in thousands, except per share data):

	Year Ended December 31,
	2020		2019
Total revenues	$	244,963	$	255,566
Income from continuing operations	$	13,576	$	11,405
Net income	$	13,576	$	12,979
Net income per share - basic	$	0.42	$	0.40
Net income per share - diluted	$	0.42	$	0.40

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, interest expense related to NurseGrid’s previously outstanding debt, 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 earliest period presented or to project the Company’s results of operations in any future period.

ShiftWizard

On October 12, 2020, the Company acquired all of the outstanding stock of ShiftWizard, Inc. (ShiftWizard) a Raleigh, North Carolina-based healthcare technology company offering a SaaS-based solution that integrates key workforce management capabilities, including scheduling, productivity, and forecasting. The consideration paid for ShiftWizard consisted of $30.2 million in cash and is subject to a post-closing working capital and purchase price adjustment, of which $0.3 million has been accrued as a liability as of December 31, 2020. Of the purchase price paid at closing, $0.5 million is being held in escrow for a period of time following the closing to serve as a source of recovery for certain potential indemnification claims by the Company. Acquisition-related transaction costs were $0.3 million. The financial results of ShiftWizard have been included in the Workforce Solutions segment from October 12, 2020.

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

Cash	$	1,091
Accounts and unbilled receivable, net		1,041
Prepaid assets		108
Operating lease right-of-use assets		183
Property and equipment		50
Indemnification assets		464
Goodwill		19,307
Intangible asset		12,660
Accounts payable and accrued liabilities		(601	)
Deferred revenue		(1,601	)
Deferred tax liability		(1,559	)
Operating lease liabilities		(183	)
Indemnification liability		(464	)
Net assets acquired	$	30,496

The excess of preliminary purchase price over the preliminary fair values of net tangible and intangible assets is recorded as goodwill. The preliminary fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The preliminary fair values of assets acquired and liabilities assumed continue to be subject to change during the measurement period (up to one year from the acquisition date) as the Company finalizes the valuation of these items. The primary areas of the preliminary purchase price allocation that are not finalized include the composition and valuation of income tax attributes and working capital. Included in the preliminary assets and liabilities is an indemnification asset and liability of $0.5 million associated with a Paycheck Protection Program loan pending forgiveness that has subsequently been forgiven. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering ShiftWizard products, and expected synergies from integrating ShiftWizard with other products or other combined functional areas within the Company. The goodwill balance is not 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 $2.7 million to an estimated fair value of $1.6 million. The $1.1 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	$	7,800	18 years
Developed technology		4,050	5 years
Non-compete		580	1 - 5 years
Trade name		230	5 years
Total preliminary intangible assets subject to amortization	$	12,660

The amounts of revenue and operating loss of ShiftWizard included in the Company’s Consolidated Statement of Income since the date of acquisition of October 12, 2020 through December 31, 2020 are as follows (in thousands):

Total revenues		$	731
Operating loss		$	(553	)

The following unaudited pro forma financial information summarizes the results of operations of the Company and ShiftWizard as though the companies were combined as of January 1, 2019 (in thousands, except per share data):

	Year Ended December 31,
	2020		2019
Total revenues	$	248,306	$	257,042
Income from continuing operations	$	13,056	$	11,604
Net income	$	13,056	$	13,178
Net income per share - basic	$	0.41	$	0.41
Net income per share - diluted	$	0.41	$	0.41

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as 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 earliest period presented or to project the Company’s results of operations in any future period.

ANSOS^TM Staff Scheduling application

On December 2, 2020, the Company acquired all of the equity interests of Change Healthcare’s staff scheduling business, consisting of the ANSOS^TM Staff Scheduling application and related products (ANSOS). The consideration paid for ANSOS was $68.0 million in cash, subject to a post-closing working capital and purchase price adjustment. Of the purchase price paid at closing, $0.3 million is being held in escrow for a period of time following the closing to serve as a source of recovery for certain potential indemnification claims by the Company. Acquisition-related transaction costs were $1.1 million. The financial results of ANSOS have been included in the Workforce Solutions segment from December 2, 2020.

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

Cash	$	1,599
Accounts and unbilled receivable, net		11,421
Prepaid assets		481
Operating lease right-of-use assets		888
Property and equipment		66
Deferred tax assets		2,938
Indemnification asset		708
Goodwill		35,258
Intangible assets		32,440
Accounts payable and accrued liabilities		(1,693	)
Deferred revenue		(14,529	)
Operating lease liabilities		(888	)
Uncertain tax position liability		(708	)
Net assets acquired	$	67,981

The excess of preliminary purchase price over the preliminary fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The preliminary fair values of assets acquired and liabilities assumed continue to be subject to change during the measurement period (up to one year from the acquisition date) as the Company finalizes the valuation of these items. The primary areas of the preliminary purchase price allocation that are not finalized include the composition and valuation of income tax attributes and working capital. Included in the preliminary assets and liabilities acquired is an indemnification asset and an uncertain tax position liability of $0.7 million determined based on management’s estimate of the most likely value related to income tax attributes. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions regarding prospective financial information with respect to the acquisition, including with respect to revenue growth, customer attrition, EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering ANSOS products, and expected synergies from integrating ANSOS with other products or other combined functional areas within the Company.

The goodwill balance 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 $17.8 million to an estimated fair value of $14.5 million. The $3.3 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	$	21,100	11 - 14 years
Developed technology		9,800	5 years
Trade name		1,540	10 years
Total preliminary intangible assets subject to amortization	$	32,440

The amounts of revenue and operating loss of ANSOS included in the Company’s Consolidated Statement of Income since the date of acquisition of December 2, 2020 through December 31, 2020 are as follows (in thousands):

Total revenues		$	959
Operating loss		$	(469	)

The following unaudited pro forma financial information summarizes the results of operations of the Company and ANSOS as though the companies were combined as of January 1, 2019 (in thousands, except per share data):

	Year Ended December 31,
	2020		2019
Total revenues	$	270,246	$	278,491
Income from continuing operations	$	18,861	$	16,534
Net income	$	18,861	$	18,108
Net income per share - basic	$	0.59	$	0.56
Net income per share - diluted	$	0.59	$	0.56

These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as 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 earliest period presented or to project the Company’s results of operations in any future period.

Providigm, LLC

On January 10, 2019, the Company acquired the outstanding equity of Providigm, LLC (Providigm), a Denver, Colorado based company focusing on quality assurance and performance improvement in healthcare, primarily serving skilled nursing facilities. The Company acquired Providigm to add its comprehensive quality management system, known as abaqis®, to its product portfolio and gain customers in the skilled nursing market. The consideration paid for Providigm consisted of $18.0 million in cash, which the Company funded with cash on hand. The Company incurred $388,000 in transaction costs, of which $63,000 was incurred during 2019 and $325,000 was incurred during 2018. The results of operations for Providigm have been included in the Workforce Solutions segment of the Company’s Financial Statements from the date of acquisition.

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

Accounts and unbilled receivable, net	$	960
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,395
Intangible assets		5,950
Accounts payable and accrued liabilities		(1,196	)
Deferred revenue		(141	)
Operating lease liabilities		(1,233	)
Net assets acquired	$	18,018

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, and EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering Providigm’s products, and expected synergies from integrating Providigm with other products or other combined functional areas within the Company. The goodwill balance 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 $266,000 to an estimated fair value of $141,000. The $125,000 write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services. The acquired assets and liabilities included a $0.8 million indemnification asset and liability determined based on management’s estimate of the most likely value related to tax liabilities.

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	$	3,500	12 years
Developed technology		2,200	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	5,950

Pro forma results of operations have not been presented as the impact of the acquisition is not material to the Company’s financial results.

CredentialMyDoc

On December 16, 2019, the Company acquired substantially all the assets of CredentialMyDoc, a Savannah, Georgia based company focusing on intuitive, easy to use, and fast to implement software-as-a-service solution, especially in ambulatory care settings. The consideration paid for CredentialMyDoc consisted of $9.0 million in cash, after giving effect to the post-closing working capital adjustment. Acquisition-related transaction costs were $90,000. The results of operations for CredentialMyDoc have been included in the Provider Solutions segment of the Company’s Financial Statements from the date of acquisition.

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

Accounts and unbilled receivable, net	$	204
Prepaid and other current assets		3
Operating lease right-of-use assets		30
Deferred tax assets		70
Goodwill		4,661
Intangible assets		4,340
Accounts payable and accrued liabilities		(7	)
Deferred revenue		(276	)
Operating lease liabilities		(30	)
Net assets acquired	$	8,995

The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions regarding prospective financial information with respect to this acquisition, including with respect to revenue growth, customer attrition, and EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering CredentialMyDoc products, and expected synergies from integrating CredentialMyDoc with other products or other combined functional areas within the Company. The goodwill balance 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 $587,000 to an estimated fair value of $276,000. The $311,000 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):

	Preliminary Fair value		Useful life
Customer relationships	$	2,100	9 years
Developed technology		2,100	4 years
Non-compete		110	5 years
Trade name		30	3 years
Total intangible assets subject to amortization	$	4,340

Pro forma results of operations have not been presented as the impact of the acquisition is not material to the Company’s financial results.

Other Business Combinations

On December 10, 2020, the Company acquired substantially all of the assets of myClinicalExchange, LLC, a Denver, Colorado-based information technologies company offering a SaaS-based solution that allows healthcare organizations to track, manage, and report the intern and clinical rotation educational requirements of medical, nursing, and allied healthcare students, as well as host required documentation for medical residents. The consideration paid for myClinicalExchange consisted of $4.4 million in cash. Of the purchase price paid at closing, $0.4 million is being held in escrow for a period of time following the closing to serve as a source of recovery for certain potential indemnification claims by the Company. Acquisition-related transaction costs were $0.1 million. The acquisition 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 myClinicalExchange are included in the Company’s consolidated financial statements from the date of acquisition and are included in the HealthStream Workforce Solutions segment.

Business Segments

12 Months Ended

Dec. 31, 2020

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 training, certification, assessment, development, and scheduling products and services (Workforce Solutions) and provider credentialing, privileging, call center, and enrollment products and services (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, information systems, 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, 2020, 2019, and 2018 (in thousands).

Revenues, net:	2020			2019			2018
Workforce Solutions	$	197,587		$	208,599		$	190,139
Provider Solutions		47,239			45,513			41,477
Total revenues, net	$	244,826		$	254,112		$	231,616

Operating income:	2020			2019			2018
Workforce Solutions	$	41,622		$	40,296		$	38,834
Provider Solutions		4,678			5,384			3,474
Unallocated		(30,482	)		(30,960	)		(26,817	)
Total operating income	$	15,818		$	14,720		$	15,491

	Assets*				Purchases of long-lived assets						Depreciation and amortization
	2020		2019		2020		2019		2018		2020		2019		2018
Workforce Solutions	$	270,924	$	118,382	$	17,586	$	14,972	$	12,820	$	12,930	$	10,813	$	9,780
Provider Solutions		140,490		148,398		2,849		2,959		5,240		10,311		9,757		8,895
Discontinued operations		—		—		—		—		180		—		—		181
Unallocated		88,899		222,764		573		13,602		7,191		6,948		7,299		5,375
Total	$	500,313	$	489,544	$	21,008	$	31,533	$	25,431	$	30,189	$	27,869	$	24,231

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

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

+ References

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+ Details

Income Taxes

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Income Taxes

10. INCOME TAXES

Components of earnings before income taxes are as follows (in thousands):

	Year Ended December 31,
	2020		2019		2018
United States	$	17,719	$	17,929	$	16,575
Foreign		105		—		—
Earnings before income taxes	$	17,824	$	17,929	$	16,575

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

	Year Ended December 31,
	2020			2019		2018
Current federal	$	(1,022	)	$	233	$	(79	)
Current state		387			634		386
Current foreign		71			—		—
Deferred federal		3,830			2,717		2,661
Deferred state		467			149		356
Deferred foreign		(1	)		—		—
Provision for income taxes	$	3,732		$	3,733	$	3,324

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,
	2020			2019			2018
Federal tax provision at the statutory rate	$	3,743		$	3,765		$	3,482
State income tax provision, net of federal benefit		787			895			658
Tax credits		(745	)		(614	)		(509	)
Change in valuation allowance		4			(247	)		2
Impact of foreign operations		7			—			—
Stock compensation		27			(117	)		(560	)
Other		(91	)		51			251
Provision for income taxes	$	3,732		$	3,733		$	3,324

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, 2020, the Company has a valuation allowance of $0.6 million recorded against deferred tax assets for state net operating losses and certain foreign deferred tax assets.

As of December 31, 2020, the Company had federal, state, and foreign net operating loss carryforwards of $13.2 million, $23.2 million, and $0.2 million, respectively. Certain losses have an indefinite carryforward period, while other loss carryforwards will expire in years 2021 through 2041. The net operating loss carryforwards may be subject to annual limitations under Internal Revenue Code Section 382. The annual limitations could result in the expiration of a portion of net operating loss and tax credit carryforwards before they are fully utilized. The Company is subject to income taxation at the federal, foreign, and various state levels. The Company is no longer subject to U.S. federal tax examinations for tax years before 2017, and with few exceptions, the Company is not subject to examination by foreign or state tax authorities for tax years which ended before 2017. Loss carryforwards and credit carryforwards generated or utilized in years earlier than 2017 are also subject to examination and adjustment.

A reconciliation of the beginning and ending liability for gross unrecognized tax benefits are as follows (in thousands):

	December 31,
	2020		2019
Balance at beginning of year	$	317	$	317
Additions for tax positions in the current year		—		—
Additions for tax positions of prior years		645		—
Balance at end of year	$	962	$	317

The Company recognized $20,000 and $14,000 for interest and penalties related to unrecognized tax benefits within the provision for income taxes during the years ended December 31, 2020 and 2019. Unrecognized tax benefits included tax positions of $317,000 for both December 31, 2020 and 2019, that if recognized would impact the Company’s effective tax rate. The balance of the remaining unrecognized tax benefits are not expected to have a rate impact due to the liability being subject to an indemnification agreement.

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,
	2020			2019
Deferred tax assets:
Allowance for doubtful accounts	$	143		$	215
Accrued liabilities		1,927			1,775
Lease liability		8,356			8,778
Tax credits		119
Stock based compensation		691			683
Deferred revenue		3,244			198
Basis difference on investments		395			381
Net operating loss carryforwards		3,692			263
Total deferred tax assets		18,567			12,293
Less: Valuation allowance		(550	)		(64	)
Deferred tax assets, net of valuation allowance		18,017			12,229
Deferred tax liabilities:
Deductible goodwill		2,614			2,236
Nondeductible intangible assets		3,752			801
Right of use assets		7,378			7,773
Prepaid assets		6,986			6,275
Capitalized software development		6,989			5,580
Depreciation		3,846			2,478
Total deferred tax liabilities		31,565			25,143

Net deferred tax liabilities	$	13,548		$	12,914

The Company realized $27,000 of excess tax expense related to stock based awards during the year ended December 31, 2020, which was reflected in the statement of income as a component of the provision for income taxes.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References + Details

Stock Based Compensation

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]

Stock Based Compensation

11. STOCK BASED COMPENSATION

Stock Incentive Plan

The Company has outstanding stock based awards under its 2016 Omnibus Incentive Plan (2016 Plan). The 2016 Plan authorizes 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. The 2016 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, 2020, 626,000 shares of common stock were available to be granted under the 2016 Plan.

Stock Option Activity

A summary of activity and various other information relative to stock options for the year ended December 31, 2020 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		—	$	—
Granted		90		20.34
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	135
Exercisable at end of period		—	$	—	$	—

Other information relative to option activity during the three years ended December 31, 2020 is as follows (in thousands):

	2020		2019		2018
Total intrinsic value of stock options exercised	$	—	$	277	$	6,130
Cash proceeds from exercise of stock options	$	—	$	214	$	2,582

The aggregate intrinsic value for stock options in the table above represents the total difference between the Company’s closing stock price on December 31, 2020 (the last trading day of the year) of $21.84 per share and the option exercise price, multiplied by the number of in-the money options as of December 31, 2020. The weighted average remaining contractual term of options outstanding at December 31, 2020 was 10 years.

Restricted Share Unit Activity

A summary of activity relative to RSUs for the year ended December 31, 2020 is as follows (in thousands, except weighted average grant date fair value):

				Weighted-
	Number of			Average Grant Date		Aggregate
	RSU’s			Fair Value		Intrinsic Value
Outstanding at beginning of period		287		$	25.61
Granted		115			22.94
Vested		(90	)		24.53
Forfeited		(13	)		24.56
Outstanding at end of period		299		$	24.95	$	6,526

The aggregate fair value of RSUs that vested during the year ended December 31, 2020 and 2019, as of the respective vesting dates, was $2.2 million and $1.9 million, respectively. A portion of RSUs that vested in 2020 and 2019 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 2020 and 2019 were 19,000 and 15,000, 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 $0.4 million in 2020, $0.4 million in 2019, and $0.3 million in 2018, and are reflected as a financing activity within the Consolidated Statements of Cash Flows.

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,
	2020		2019		2018
Cost of revenues (excluding depreciation and amortization)	$	41	$	699	$	37
Product development		363		956		296
Sales and marketing		199		614		183
Other general and administrative		1,615		1,975		1,261
Total stock based compensation expense	$	2,218	$	4,244	$	1,777

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, 2020, total unrecognized compensation expense related to non-vested stock options and RSUs was $4.3 million, net of estimated forfeitures, with a weighted average expense recognition period remaining of 2.6 years. The Company realized $27,000 of excess tax expense related to stock based awards during the year ended December 31, 2020, which was reflected in the Consolidated 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.

Stock Awards

During June 2019, the Company’s Chief Executive Officer, Robert A. Frist, Jr., contributed 78,520 of his personally owned shares of HealthStream, Inc. common stock (valued at $2.0 million) to the Company, without any consideration paid to him, for the benefit of the Company’s employees. In connection therewith, effective June 26, 2019 the Company approved the award of 78,520 fully vested shares of common stock to approximately 820 employees of the Company under the HealthStream, Inc. 2016 Omnibus Incentive Plan. These shares were issued in July 2019. As required by ASC Topic 718, Compensation – Stock Compensation, the Company recognized $2.0 million of stock based compensation expense for these stock awards during the three months ended June 30, 2019 based on the closing fair market value of the Company’s stock on the date of the Company’s approval of these grants. Total payments related to the employees’ tax obligations to taxing authorities for these stock awards were $0.6 million and are reflected as a financing activity within the Consolidated Statement of Cash Flows for 2019. In addition, the employer taxes and expenses associated with these grants were $0.2 million and were recorded as an expense during June 2019. Mr. Frist contributed an additional 7,852 of his personally owned shares to cover these costs. The receipt of shares from Mr. Frist and in connection with the withholding of shares as set forth above are presented on the Company’s Statement of Shareholders’ Equity in a similar manner as a share repurchase (i.e., reduction of outstanding shares).

Employee Benefit Plan

12 Months Ended

Dec. 31, 2020

Compensation And Retirement Disclosure [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 $1.2 million, $1.4 million, and $1.3 million for the years ended December 31, 2020, 2019, and 2018, respectively.

- Definition

The entire disclosure for retirement benefits.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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-Name Accounting Standards Codification
-Topic 715
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-Section 55
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
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+ Details

Discontinued Operations

12 Months Ended

Dec. 31, 2020

Discontinued Operations And Disposal Groups [Abstract]

Discontinued Operations

13. DISCONTINUED OPERATIONS

On February 12, 2018, the Company divested its PX business to Press Ganey for $65.2 million in cash (after giving effect to the post-closing working capital adjustment), resulting in a gain, net of tax, of $20.5 million, of which $19.0 million was recorded during the year ended December 31, 2018 and $1.5 million was recorded during the year ended December 31, 2019. This sale of the PX business resulted in the divestiture of the Company’s patient experience solutions business segment. The Company has classified the results of its PX business segment as discontinued operations in its Consolidated Statements of Income and Cash Flows for all periods presented.

Debt

12 Months Ended

Dec. 31, 2020

Debt Disclosure [Abstract]

Debt

14. DEBT

At December 31, 2020 and 2019, the Company had no debt outstanding.

Revolving Credit Facility

The Company entered into a Third Amendment to Revolving Credit Agreement (Revolving Credit Facility), amending the Revolving Credit Facility, dated as of November 24, 2014 with Truist Bank, successor by merger to SunTrust Bank (Truist), extending the maturity date to October 28, 2023. The Amendment also increased the capacity under the Revolving Credit Facility to $65.0 million, which continues to include 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. In addition, the Amendment, among other things, (i) increased the basket for dividends to $65.0 million so long as the pro forma leverage ratio is less than or equal to 1.50:1.00 and the Company has minimum liquidity of $30.0 million, (ii) increased the basket for permitted minority owned investments to $20.0 million, (iii) added a LIBOR floor of 0.50%, and (iv) adjusted the applicable margin. 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 Truist’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 1.75%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 0.75%. Commitment fees and letter of credit fees are also payable under the Revolving Credit Facility. Principal is payable in full at maturity on October 28, 2023, 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 obligations under the Revolving Credit Facility are guaranteed by each of the Company’s subsidiaries.

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, 2020, the Company was in compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of December 31, 2020 and there were no borrowings under the Revolving Credit Facility during the year ended December 31, 2020.

Leases

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Leases

15. LEASES

During 2020, the Company acquired operating leases as part of its acquisitions of NurseGrid, Shiftwizard, and ANSOS, resulting in a $1.1 million ROU asset and lease liability. As of December 31, 2020, the Company did not have any leases that have not yet commenced.

The Company’s operating lease expense as presented in other general and administrative expense in the Consolidated Statement of Income was $4.8 million and $4.9 million for the twelve months ended December 31, 2020 and 2019. Cash paid for amounts included in the measurement of operating lease liabilities was $4.9 million and $2.5 million for the year ended December 31, 2020 and December 31, 2019. As of December 31, 2020, the weighted-average remaining lease term was 9.6 years, and the weighted-average incremental borrowing rate was 6%.

The table below presents the lease-related assets and liabilities recorded on the Consolidated Balance Sheet as of December 31, 2020 (in thousands).

		Year Ended December 31,
		2020		2019
Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	28,081	$	29,615
Total leased assets		$	28,081	$	29,615
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	3,390	$	2,797
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		28,479		30,733
Total operating lease liabilities		$	31,869	$	33,530

The table below presents the maturities of lease liabilities under non-cancellable leases as of December 31, 2020 (in thousands).

2021	$	5,229
2022		4,430
2023		4,130
2024		4,176
2025		3,942
Thereafter		20,650
Total undiscounted lease payments	$	42,557
Less imputed interest		10,688
Total lease liabilities	$	31,869

Litigation

12 Months Ended

Dec. 31, 2020

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.

Non-Marketable Equity Investments

12 Months Ended

Dec. 31, 2020

Investments Debt And Equity Securities [Abstract]

Non-Marketable Equity Investments

17. NON-MARKETABLE EQUITY INVESTMENTS

The aggregate carrying amount of non-marketable equity investments accounted for using the measurement alternative for equity investments that do not have readily determinable fair values was $3.9 million and $5.9 million for the years ended December 31, 2020 and 2019, respectively, which carrying value we evaluate for impairment at each reporting period. During the year ended December 31, 2020, the Company recorded a $1.2 million upward adjustment to the carrying value of our non-marketable equity investment in NurseGrid due to a change in fair value based on the consideration paid upon the Company’s acquisition of NurseGrid on March 9, 2020 (see Note 8). Cumulatively, the Company has recorded $0.1 million in downward adjustments to the carrying value of non-marketable equity investments. Such is the combination of cumulative downward adjustments of $1.3 million offset by cumulative upward adjustments of $1.2 million. Cumulatively, the Company has recorded $1.3 million in reductions to the carrying value of non-marketable equity investments due to downward changes in fair value based on observable prices from orderly transactions for similar investments made in the investee. The fair value of non-marketable equity investments is not estimated if there are no identified events or changes in circumstances that may have a significant adverse effect on the fair value of the investment.

Subsequent Event

12 Months Ended

Dec. 31, 2020

Subsequent Events [Abstract]

Subsequent Events

18. SUBSEQUENT EVENT

On January 19, 2021, the Company acquired the issued and outstanding equity of ProcessDATA, Ltd. (d/b/a ComplyALIGN and HospitalPORTAL), a Chicago, Illinois-based healthcare technology company offering a SaaS-based policy management system for healthcare organizations, for $2.0 million in cash, subject to customary price adjustments. The acquisition 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 ComplyALIGN are included in the Company’s consolidated financial statements from the date of acquisition and are included in the HealthStream Workforce Solutions segment.

Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2020

Accounting Policies [Abstract]

Recently Adopted Accounting Standards

Recognition of Revenue

Revenue is recognized based on the following five step model:

•

Identification of the contract with a customer

•

Identification of the performance obligations in the contract

•

Determination of the transaction price

•

Allocation of the transaction price to the performance obligations in the contract

•

Recognition of revenue when, or as, the Company satisfies a performance obligation

Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations.

Basis of Presentation

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

Cash Equivalents

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

Marketable Securities

Deferred Commissions

Prepaid Royalties

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
2020	$	843	$	274	$	(568	)	$	549
2019		1,161		211		(529	)		843
2018		1,979		1,033		(1,851	)		1,161

Capitalized Software Development

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

	Years
Furniture and fixtures	5 - 7
Equipment		3

Goodwill and Intangible Assets

Long-Lived Assets

Non-Marketable Equity Investments

Financial Instruments

Advertising

Shipping and Handling Costs

Income Taxes

Earnings Per Share

Earnings per Share

Concentrations of Credit Risk and Significant Customers

Stock Based Compensation

Leases

Foreign Currency

Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2020

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
2020	$	843	$	274	$	(568	)	$	549
2019		1,161		211		(529	)		843
2018		1,979		1,033		(1,851	)		1,161

Estimated Useful Lives of Property and Equipment

	Years
Furniture and fixtures	5 - 7
Equipment		3

Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2020

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, 2020 (in thousands, except per share amounts):

	Year Ended December 31,
	2020		2019		2018
Numerator:
Income from continuing operations	$	14,091	$	14,196	$	13,251
Income from discontinued operations		—		1,574		18,966
Net income	$	14,091	$	15,770	$	32,217
Denominator:
Weighted-average shares outstanding		31,960		32,372		32,264
Effect of dilutive shares		29		56		71
Weighted-average diluted shares		31,989		32,428		32,335

Net income per share – basic:
Continuing operations	$	0.44	$	0.44	$	0.41
Discontinued operations		—		0.05		0.59
Net income per share - basic	$	0.44	$	0.49	$	1.00

Net income per share – diluted:
Continuing operations	$	0.44	$	0.44	$	0.41
Discontinued operations		—		0.05		0.59
Net income per share - diluted	$	0.44	$	0.49	$	1.00

Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2020

Investments Debt And Equity Securities [Abstract]

Fair Value of Available for Sale Marketable Securities

At December 31, 2020 and 2019, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	December 31, 2020
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value		Cash and Cash Equivalents		Current Marketable Securities
Cash	$	31,558	$	—	$	—		$	31,558	$	31,558	$	—
Level 2:
Time deposits		10,021		—		—			10,021		5,008		5,013
Corporate debt securities		4,923		—		(8	)		4,915		—		4,915
Total	$	46,502	$	—	$	(8	)	$	46,494	$	36,566	$	9,928

	December 31, 2019
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value		Cash and Cash Equivalents		Current Marketable Securities
Cash	$	131,538	$	—	$	—		$	131,538	$	131,538	$	—
Level 2:
Corporate debt securities		37,325		7		(5	)		37,327		—		37,327
Government-sponsored enterprise debt securities		4,001		—		—			4,001		—		4,001
Total	$	172,864		7		(5	)	$	172,866	$	131,538	$	41,328

Revenue Recognition and Sales Commissions (Tables)

12 Months Ended

Dec. 31, 2020

Revenue From Contract With Customer [Abstract]

Schedule of Revenues Included in Continuing Operations from Contracts with Customers Disaggregated by Revenue Source

	Year Ended December 31, 2020
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	193,673	$	40,237	$	233,910
Professional services		3,914		7,002		10,916
Total revenues, net	$	197,587	$	47,239	$	244,826

	Year Ended December 31, 2019
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	202,479	$	38,022	$	240,501
Professional services		6,120		7,491		13,611
Total revenues, net	$	208,599	$	45,513	$	254,112

	Year Ended December 31, 2018
Business Segments	Workforce Solutions		Provider Solutions		Consolidated
Subscription services	$	184,926	$	35,542	$	220,468
Professional services		5,213		5,935		11,148
Total revenues, net	$	190,139	$	41,477	$	231,616

Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2020

Property Plant And Equipment [Abstract]

Summary of Property and Equipment

Property and equipment consist of the following (in thousands):

	December 31,
	2020			2019
Equipment	$	21,401		$	25,199
Leasehold improvements		14,980			14,909
Furniture and fixtures		5,074			5,248
Gross property and equipment		41,455			45,356
Accumulated depreciation and amortization		(19,237	)		(19,291	)
Property and equipment, net	$	22,218		$	26,065

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2020

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, 2020 and 2019 are as follows (in thousands):

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2020	$	27,776	$	74,420	$	102,196
Acquisition of NurseGrid		21,085		—		21,085
Acquisition of ShiftWizard		19,307		—		19,307
Acquisition of ANSOS		35,258		—		35,258
Acquisition of myClinicalExchange		590		—		590
Post-closing adjustment for CredentialMyDoc		—		4		4
Balance at December 31, 2020	$	104,016	$	74,424	$	178,440

	Workforce Solutions		Provider Solutions		Total
Balance at January 1, 2019	$	16,381	$	69,763	$	86,144
Acquisition of Providigm, LLC		11,395		—		11,395
Acquisition of CredentialMyDoc		—		4,657		4,657
Balance at December 31, 2019	$	27,776	$	74,420	$	102,196

Identifiable Intangible Assets

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

	As of December 31, 2020							As of December 31, 2019
	Gross Amount		Accumulated Amortization			Net		Gross Amount		Accumulated Amortization			Net
Customer related	$	113,650	$	(36,723	)	$	76,927	$	82,314	$	(29,760	)	$	52,554
Other		34,536		(10,748	)		23,788		20,262		(12,735	)		7,527
Total	$	148,186	$	(47,471	)	$	100,715	$	102,576	$	(42,495	)	$	60,081

Expected Annual Amortization Expense

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

2021	$	14,723
2022		13,599
2023		12,937
2024		11,440
2025		10,724
Thereafter		36,593
Total	$	100,016

Business Combinations (Tables)

12 Months Ended

Dec. 31, 2020

NurseGrid [Member]

Summary of Purchase Price

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

Cash paid at closing	$	25,485
Post-closing adjustment, net of cash received		33
Cash acquired		(4,064	)
Net consideration paid		21,454
Fair value of existing equity interest in NurseGrid		3,623
Net consideration paid	$	25,077

Summary of Preliminary 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 and unbilled receivable, net	$	92
Prepaid and other current assets		155
Operating lease right-of-use assets		50
Deferred tax assets		2,121
Goodwill		21,085
Intangible assets		1,845
Accounts payable and accrued liabilities		(143	)
Deferred revenue		(78	)
Operating lease liabilities		(50	)
Net assets acquired	$	25,077

Summary of 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	$	35	8 years
Developed technology		1,110	5 years
Trade name		700	Indefinite
Total intangible assets	$	1,845

Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statement of Income since the Date of Acquisition

Total revenues		$	219
Operating loss		$	(2,650	)

Summary of Unaudited Pro Forma Financial Information

	Year Ended December 31,
	2020		2019
Total revenues	$	244,963	$	255,566
Income from continuing operations	$	13,576	$	11,405
Net income	$	13,576	$	12,979
Net income per share - basic	$	0.42	$	0.40
Net income per share - diluted	$	0.42	$	0.40

ShiftWizard [Member]

Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed

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

Cash	$	1,091
Accounts and unbilled receivable, net		1,041
Prepaid assets		108
Operating lease right-of-use assets		183
Property and equipment		50
Indemnification assets		464
Goodwill		19,307
Intangible asset		12,660
Accounts payable and accrued liabilities		(601	)
Deferred revenue		(1,601	)
Deferred tax liability		(1,559	)
Operating lease liabilities		(183	)
Indemnification liability		(464	)
Net assets acquired	$	30,496

Summary of 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	$	7,800	18 years
Developed technology		4,050	5 years
Non-compete		580	1 - 5 years
Trade name		230	5 years
Total preliminary intangible assets subject to amortization	$	12,660

Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statement of Income since the Date of Acquisition

Total revenues		$	731
Operating loss		$	(553	)

Summary of Unaudited Pro Forma Financial Information

	Year Ended December 31,
	2020		2019
Total revenues	$	248,306	$	257,042
Income from continuing operations	$	13,056	$	11,604
Net income	$	13,056	$	13,178
Net income per share - basic	$	0.41	$	0.41
Net income per share - diluted	$	0.41	$	0.41

ANSOSTM Staff Scheduling Application [Member]

Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed

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

Cash	$	1,599
Accounts and unbilled receivable, net		11,421
Prepaid assets		481
Operating lease right-of-use assets		888
Property and equipment		66
Deferred tax assets		2,938
Indemnification asset		708
Goodwill		35,258
Intangible assets		32,440
Accounts payable and accrued liabilities		(1,693	)
Deferred revenue		(14,529	)
Operating lease liabilities		(888	)
Uncertain tax position liability		(708	)
Net assets acquired	$	67,981

Summary of 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	$	21,100	11 - 14 years
Developed technology		9,800	5 years
Trade name		1,540	10 years
Total preliminary intangible assets subject to amortization	$	32,440

Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statement of Income since the Date of Acquisition

Total revenues		$	959
Operating loss		$	(469	)

Summary of Unaudited Pro Forma Financial Information

	Year Ended December 31,
	2020		2019
Total revenues	$	270,246	$	278,491
Income from continuing operations	$	18,861	$	16,534
Net income	$	18,861	$	18,108
Net income per share - basic	$	0.59	$	0.56
Net income per share - diluted	$	0.59	$	0.56

Providigm, LLC [Member]

Summary of Preliminary 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 and unbilled receivable, net	$	960
Prepaid assets		847
Property and equipment		50
Operating lease right-of-use assets		1,233
Other assets		49
Deferred tax assets		104
Goodwill		11,395
Intangible assets		5,950
Accounts payable and accrued liabilities		(1,196	)
Deferred revenue		(141	)
Operating lease liabilities		(1,233	)
Net assets acquired	$	18,018

Summary of 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	$	3,500	12 years
Developed technology		2,200	5 years
Trade Name		250	7 years
Total preliminary intangible assets subject to amortization	$	5,950

CredentialMyDoc [Member]

Summary of Preliminary 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 and unbilled receivable, net	$	204
Prepaid and other current assets		3
Operating lease right-of-use assets		30
Deferred tax assets		70
Goodwill		4,661
Intangible assets		4,340
Accounts payable and accrued liabilities		(7	)
Deferred revenue		(276	)
Operating lease liabilities		(30	)
Net assets acquired	$	8,995

Summary of 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):

	Preliminary Fair value		Useful life
Customer relationships	$	2,100	9 years
Developed technology		2,100	4 years
Non-compete		110	5 years
Trade name		30	3 years
Total intangible assets subject to amortization	$	4,340

Business Segments (Tables)

12 Months Ended

Dec. 31, 2020

Segment Reporting [Abstract]

Business Segment Information Based on Net Revenues and Operating Income

The following is the Company’s business segment information as of and for the years ended December 31, 2020, 2019, and 2018 (in thousands).

Revenues, net:	2020			2019			2018
Workforce Solutions	$	197,587		$	208,599		$	190,139
Provider Solutions		47,239			45,513			41,477
Total revenues, net	$	244,826		$	254,112		$	231,616

Operating income:	2020			2019			2018
Workforce Solutions	$	41,622		$	40,296		$	38,834
Provider Solutions		4,678			5,384			3,474
Unallocated		(30,482	)		(30,960	)		(26,817	)
Total operating income	$	15,818		$	14,720		$	15,491

Business Segment Information Based on Assets

	Assets*				Purchases of long-lived assets						Depreciation and amortization
	2020		2019		2020		2019		2018		2020		2019		2018
Workforce Solutions	$	270,924	$	118,382	$	17,586	$	14,972	$	12,820	$	12,930	$	10,813	$	9,780
Provider Solutions		140,490		148,398		2,849		2,959		5,240		10,311		9,757		8,895
Discontinued operations		—		—		—		—		180		—		—		181
Unallocated		88,899		222,764		573		13,602		7,191		6,948		7,299		5,375
Total	$	500,313	$	489,544	$	21,008	$	31,533	$	25,431	$	30,189	$	27,869	$	24,231

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2020

Income Tax Disclosure [Abstract]

Schedule of Components of Earnings Before Income Taxes

Components of earnings before income taxes are as follows (in thousands):

	Year Ended December 31,
	2020		2019		2018
United States	$	17,719	$	17,929	$	16,575
Foreign		105		—		—
Earnings before income taxes	$	17,824	$	17,929	$	16,575

Summary of Provision for Income Taxes

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

	Year Ended December 31,
	2020			2019		2018
Current federal	$	(1,022	)	$	233	$	(79	)
Current state		387			634		386
Current foreign		71			—		—
Deferred federal		3,830			2,717		2,661
Deferred state		467			149		356
Deferred foreign		(1	)		—		—
Provision for income taxes	$	3,732		$	3,733	$	3,324

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

	Year Ended December 31,
	2020			2019			2018
Federal tax provision at the statutory rate	$	3,743		$	3,765		$	3,482
State income tax provision, net of federal benefit		787			895			658
Tax credits		(745	)		(614	)		(509	)
Change in valuation allowance		4			(247	)		2
Impact of foreign operations		7			—			—
Stock compensation		27			(117	)		(560	)
Other		(91	)		51			251
Provision for income taxes	$	3,732		$	3,733		$	3,324

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 are as follows (in thousands):

	December 31,
	2020		2019
Balance at beginning of year	$	317	$	317
Additions for tax positions in the current year		—		—
Additions for tax positions of prior years		645		—
Balance at end of year	$	962	$	317

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,
	2020			2019
Deferred tax assets:
Allowance for doubtful accounts	$	143		$	215
Accrued liabilities		1,927			1,775
Lease liability		8,356			8,778
Tax credits		119
Stock based compensation		691			683
Deferred revenue		3,244			198
Basis difference on investments		395			381
Net operating loss carryforwards		3,692			263
Total deferred tax assets		18,567			12,293
Less: Valuation allowance		(550	)		(64	)
Deferred tax assets, net of valuation allowance		18,017			12,229
Deferred tax liabilities:
Deductible goodwill		2,614			2,236
Nondeductible intangible assets		3,752			801
Right of use assets		7,378			7,773
Prepaid assets		6,986			6,275
Capitalized software development		6,989			5,580
Depreciation		3,846			2,478
Total deferred tax liabilities		31,565			25,143

Net deferred tax liabilities	$	13,548		$	12,914

Stock Based Compensation (Tables)

12 Months Ended

Dec. 31, 2020

Disclosure Of Compensation Related Costs Sharebased 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, 2020 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		—	$	—
Granted		90		20.34
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	135
Exercisable at end of period		—	$	—	$	—

Other Information Relative to Option Activity

Other information relative to option activity during the three years ended December 31, 2020 is as follows (in thousands):

	2020		2019		2018
Total intrinsic value of stock options exercised	$	—	$	277	$	6,130
Cash proceeds from exercise of stock options	$	—	$	214	$	2,582

Summary of Activity Relative to RSU's

A summary of activity relative to RSUs for the year ended December 31, 2020 is as follows (in thousands, except weighted average grant date fair value):

				Weighted-
	Number of			Average Grant Date		Aggregate
	RSU’s			Fair Value		Intrinsic Value
Outstanding at beginning of period		287		$	25.61
Granted		115			22.94
Vested		(90	)		24.53
Forfeited		(13	)		24.56
Outstanding at end of period		299		$	24.95	$	6,526

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,
	2020		2019		2018
Cost of revenues (excluding depreciation and amortization)	$	41	$	699	$	37
Product development		363		956		296
Sales and marketing		199		614		183
Other general and administrative		1,615		1,975		1,261
Total stock based compensation expense	$	2,218	$	4,244	$	1,777

Leases (Tables)

12 Months Ended

Dec. 31, 2020

Leases [Abstract]

Schedule of Lease-Related Assets and Liabilities Recorded on Condensed Consolidated Balance Sheet

The table below presents the lease-related assets and liabilities recorded on the Consolidated Balance Sheet as of December 31, 2020 (in thousands).

		Year Ended December 31,
		2020		2019
Assets	Classification
Operating lease right-of-use assets	Operating lease right of use assets, net	$	28,081	$	29,615
Total leased assets		$	28,081	$	29,615
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	3,390	$	2,797
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		28,479		30,733
Total operating lease liabilities		$	31,869	$	33,530

Schedule of Maturities of Lease Liabilities Under Non-Cancellable Leases

The table below presents the maturities of lease liabilities under non-cancellable leases as of December 31, 2020 (in thousands).

2021	$	5,229
2022		4,430
2023		4,130
2024		4,176
2025		3,942
Thereafter		20,650
Total undiscounted lease payments	$	42,557
Less imputed interest		10,688
Total lease liabilities	$	31,869

Summary of Significant Accounting Policies - Additional Information (Detail)		12 Months Ended
	Feb. 12, 2018 USD ($)	Dec. 31, 2020 USD ($) Segment SourcesofTaxableIncome Plan	Dec. 31, 2019 USD ($)	Dec. 31, 2018 USD ($)
Business And Basis Of Presentation [Line Items]
Number of operating segments \| Segment		2
Maturity of unrestricted cash equivalent		less than three months
Deferred commissions, amortization period		3 years
Assets amortized cost		3 years
Capitalized software development amount		$ 17,900,000	$ 14,100,000
Amortization of capitalized software development from continuing operations		12,700,000	11,000,000.0	$ 9,600,000
Capitalized software development costs for external computer software developed for resale		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
Number of sources of taxable income \| SourcesofTaxableIncome		4
Valuation allowance		$ 550,000	64,000
Concentration risk, customer		The Company did not have any single customer representing over 10% of net revenues or accounts receivable during 2020, 2019, or 2018
Number of stock based compensation plan \| Plan		1
Sales and Marketing Expense [Member]
Business And Basis Of Presentation [Line Items]
Advertising expense		$ 1,100,000	$ 800,000	$ 700,000
Minimum [Member]
Business And Basis Of Presentation [Line Items]
Royalty payments amortization period		1 year
Finite lived intangible assets amortization period		3 years
Maximum [Member]
Business And Basis Of Presentation [Line Items]
Royalty payments amortization period		5 years
Finite lived intangible assets amortization period		18 years
Weighted Average [Member]
Business And Basis Of Presentation [Line Items]
Finite lived intangible assets amortization period		11 years 4 months 24 days
ASU 2016-13 [Member]
Business And Basis Of Presentation [Line Items]
Change in accounting principle, accounting standards update, adopted		true
Change in accounting principle, accounting standards update, adoption date		Jan. 01, 2020
Change in accounting principle, accounting standards update, immaterial effect		true
ASU 2016-02 [Member]
Business And Basis Of Presentation [Line Items]
Change in accounting principle, accounting standards update, adopted		true
Change in accounting principle, accounting standards update, adoption date		Jan. 01, 2019
Patient Experience Solutions [Member]
Business And Basis Of Presentation [Line Items]
Consideration received	$ 65,200,000

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Allowance Balance at Beginning of Period	$ 843	$ 1,161	$ 1,979
Charged to Costs and Expenses	274	211	1,033
Write-offs	(568)	(529)	(1,851)
Allowance Balance at End of Period	$ 549	$ 843	$ 1,161

Summary of Significant Accounting Policies - Estimated Useful Lives of Property and Equipment (Detail)	12 Months Ended
	Dec. 31, 2020
Furniture and Fixtures [Member] \| Minimum [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	5 years
Furniture and Fixtures [Member] \| Maximum [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	7 years
Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment useful life	3 years

Shareholders' Equity - Additional Information (Detail) - USD ($)		12 Months Ended
	Mar. 13, 2020	Dec. 31, 2020	Dec. 31, 2019
Equity [Abstract]
Common stock, shares authorized		75,000,000	75,000,000
Common stock, shares issued		31,493,000	32,379,000
Common stock, shares outstanding		31,493,000	32,379,000
Preferred stock, shares authorized		10,000,000
Stock repurchase program, authorized amount	$ 30,000,000.0
Stock repurchase program, termination date	Mar. 12, 2021
Share repurchased, shares		957,367
Share repurchased, fair value		$ 20,019,000
Share repurchased, average price per share		$ 20.89

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Numerator:
Income from continuing operations	$ 14,091	$ 14,196	$ 13,251
Income from discontinued operations		1,574	18,966
Net income	$ 14,091	$ 15,770	$ 32,217
Denominator:
Weighted-average shares outstanding	31,960	32,372	32,264
Effect of dilutive shares	29	56	71
Weighted-average diluted shares	31,989	32,428	32,335
Net income per share – basic:
Continuing operations	$ 0.44	$ 0.44	$ 0.41
Discontinued operations		0.05	0.59
Net income per share - basic	0.44	0.49	1.00
Net income per share – diluted:
Continuing operations	0.44	0.44	0.41
Discontinued operations		0.05	0.59
Net income per share - diluted	$ 0.44	$ 0.49	$ 1.00

Earnings Per Share - Additional Information (Detail) - shares	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Earnings Per Share [Abstract]
Total number of common equivalent shares excluded from the calculations of diluted earnings per share	122,000	93,000	91,000

Marketable Securities - Fair Value of Available for Sale Marketable Securities (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Schedule of Available-for-sale Securities [Line Items]
Adjusted Cost	$ 46,502	$ 172,864
Unrealized Gains		7
Unrealized Losses	(8)	(5)
Fair Value	46,494	172,866
Cash and Cash Equivalents	36,566	131,538
Current Marketable Securities	9,928	41,328
Cash [Member]
Schedule of Available-for-sale Securities [Line Items]
Adjusted Cost	31,558	131,538
Fair Value	31,558	131,538
Cash and Cash Equivalents	31,558	131,538
Level 2 [Member] \| Corporate Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Adjusted Cost	4,923	37,325
Unrealized Gains		7
Unrealized Losses	(8)	(5)
Fair Value	4,915	37,327
Current Marketable Securities	4,915	37,327
Level 2 [Member] \| Time Deposits [Member]
Schedule of Available-for-sale Securities [Line Items]
Adjusted Cost	10,021
Fair Value	10,021
Cash and Cash Equivalents	5,008
Current Marketable Securities	$ 5,013
Level 2 [Member] \| Government-Sponsored Enterprises Debt Securities [Member]
Schedule of Available-for-sale Securities [Line Items]
Adjusted Cost		4,001
Fair Value		4,001
Current Marketable Securities		$ 4,001

Revenue Recognition and Sales Commissions - Schedule of Revenues Included in Continuing Operations Disaggregated by Revenue Source (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 244,826	$ 254,112	$ 231,616
Subscription Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	233,910	240,501	220,468
Professional Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	10,916	13,611	11,148
Workforce Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	197,587	208,599	190,139
Workforce Solutions [Member] \| Subscription Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	193,673	202,479	184,926
Workforce Solutions [Member] \| Professional Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	3,914	6,120	5,213
Provider Solutions [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	47,239	45,513	41,477
Provider Solutions [Member] \| Subscription Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	40,237	38,022	35,542
Provider Solutions [Member] \| Professional Services [Member]
Disaggregation Of Revenue [Line Items]
Total revenues, net	$ 7,002	$ 7,491	$ 5,935

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
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-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Revenue Recognition and Sales Commissions - Additional Information (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenue Recognition and Sales Commissions [Line Items]
Revenues recognized in period, included in deferred revenue at beginning of the period	$ 64,500	$ 64,700	$ 63,700
Estimated revenue expected to be recognized in future under contract with customers	$ 464,000
Description of sales commission plan	Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer.
Sales Commissions, amortization term description	Non-commensurate commissions are amortized over the greater of the contract term or technological obsolescence period of approximately three years.
Sales Commissions, amortization period	3 years
Amortization of deferred commissions	$ 8,768	8,305	$ 7,659
Customer Contracts [Member]
Revenue Recognition and Sales Commissions [Line Items]
Impairment losses on receivables and contract asset	$ 300	$ 200

Revenue Recognition and Sales Commissions - Additional Information (Detail 1) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date: 2021-01-01	Dec. 31, 2020
Revenue Recognition and Sales Commissions [Line Items]
Estimated revenue, expected recognition period	12 months
Percentage of remaining performance obligations expects revenue	47.00%

Property and Equipment - Summary of Property and Equipment (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 41,455	$ 45,356
Accumulated depreciation and amortization	(19,237)	(19,291)
Property and equipment, net	22,218	26,065
Equipment [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	21,401	25,199
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	14,980	14,909
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Gross property and equipment	$ 5,074	$ 5,248

Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Property Plant And Equipment [Abstract]
Depreciation of property and equipment	$ 6.9	$ 7.3	$ 5.5

Goodwill and Intangible Assets - Changes in Carrying Amount of Goodwill (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Goodwill [Line Items]
Goodwill, beginning balance	$ 102,196	$ 86,144
Goodwill, ending balance	178,440	102,196
NurseGrid [Member]
Goodwill [Line Items]
Goodwill acquired	21,085
ShiftWizard [Member]
Goodwill [Line Items]
Goodwill acquired	19,307
ANSOS [Member]
Goodwill [Line Items]
Goodwill acquired	35,258
myClincalExchange [Member]
Goodwill [Line Items]
Goodwill acquired	590
CredentialMyDoc [Member]
Goodwill [Line Items]
Goodwill acquired		4,657
Post-closing adjustment	4
Providigm, LLC [Member]
Goodwill [Line Items]
Goodwill acquired		11,395
Workforce Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	27,776	16,381
Goodwill, ending balance	104,016	27,776
Workforce Solutions [Member] \| NurseGrid [Member]
Goodwill [Line Items]
Goodwill acquired	21,085
Workforce Solutions [Member] \| ShiftWizard [Member]
Goodwill [Line Items]
Goodwill acquired	19,307
Workforce Solutions [Member] \| ANSOS [Member]
Goodwill [Line Items]
Goodwill acquired	35,258
Workforce Solutions [Member] \| myClincalExchange [Member]
Goodwill [Line Items]
Goodwill acquired	590
Workforce Solutions [Member] \| Providigm, LLC [Member]
Goodwill [Line Items]
Goodwill acquired		11,395
Provider Solutions [Member]
Goodwill [Line Items]
Goodwill, beginning balance	74,420	69,763
Goodwill, ending balance	74,424	74,420
Provider Solutions [Member] \| CredentialMyDoc [Member]
Goodwill [Line Items]
Goodwill acquired		$ 4,657
Post-closing adjustment	$ 4

Goodwill and Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Goodwill [Line Items]
Amortization of intangible assets	$ 10.5	$ 9.6	$ 9.1
Trade Name [Member]
Goodwill [Line Items]
Indefinite-lived Intangible	$ 0.7
Minimum [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	3 years
Minimum [Member] \| Customer Relationships [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	5 years
Minimum [Member] \| Other Intangible Assets [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	1 year
Maximum [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	18 years
Maximum [Member] \| Customer Relationships [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	18 years
Maximum [Member] \| Other Intangible Assets [Member]
Goodwill [Line Items]
Finite lived intangible assets amortization period	9 years

Goodwill and Intangible Assets - Identifiable Intangible Assets (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Finite Lived Intangible Assets [Line Items]
Gross Amount	$ 148,186	$ 102,576
Accumulated Amortization	(47,471)	(42,495)
Net	100,715	60,081
Customer Relationships [Member]
Finite Lived Intangible Assets [Line Items]
Gross Amount	113,650	82,314
Accumulated Amortization	(36,723)	(29,760)
Net	76,927	52,554
Other Intangible Assets [Member]
Finite Lived Intangible Assets [Line Items]
Gross Amount	34,536	20,262
Accumulated Amortization	(10,748)	(12,735)
Net	$ 23,788	$ 7,527

Goodwill and Intangible Assets - Expected Annual Amortization Expense (Detail) $ in Thousands	Dec. 31, 2020 USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
2021	$ 14,723
2022	13,599
2023	12,937
2024	11,440
2025	10,724
Thereafter	36,593
Total	$ 100,016

Business Combinations - Additional Information (Detail) - USD ($)							3 Months Ended	12 Months Ended	24 Months Ended
	Dec. 10, 2020	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020	Dec. 16, 2019	Jan. 10, 2019	Sep. 30, 2018	Dec. 31, 2019	Dec. 31, 2019
NurseGrid [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash				$ 21,500,000
Fair value of existing equity interest				3,623,000
Gain recognized from remeasurement of equity interest				1,200,000
Acquisition-related transaction costs				200,000
Net tangible assets include deferred revenue book value at acquisition date				157,000
Net tangible assets include deferred revenue fair value at acquisition date				78,000
Write-down of deferred revenue				$ 79,000
ShiftWizard [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash			$ 30,200,000
Acquisition-related transaction costs			300,000
Net tangible assets include deferred revenue book value at acquisition date			2,700,000
Net tangible assets include deferred revenue fair value at acquisition date			1,601,000
Write-down of deferred revenue			1,100,000
Purchase price adjustments accrued			300,000
ShiftWizard [Member] \| Recovery of Working Capital Adjustment and Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow			$ 500,000
ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash		$ 68,000,000.0
Acquisition-related transaction costs		1,100,000
Net tangible assets include deferred revenue book value at acquisition date		17,800,000
Net tangible assets include deferred revenue fair value at acquisition date		14,529,000
Write-down of deferred revenue		3,300,000
Business combination, indemnification assets and liability related to tax liabilities		700,000
ANSOSTM Staff Scheduling Application [Member] \| Recovery of Working Capital Adjustment and Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow		$ 300,000
Providigm, LLC [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash						$ 18,000,000.0
Net tangible assets include deferred revenue book value at acquisition date						266,000
Net tangible assets include deferred revenue fair value at acquisition date						141,000
Write-down of deferred revenue						125,000
Business combination, indemnification assets and liability related to tax liabilities						$ 800,000
Transaction costs							$ 325,000	$ 63,000	$ 388,000
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash					$ 9,000,000.0
Acquisition-related transaction costs					90,000
Net tangible assets include deferred revenue book value at acquisition date					587,000
Net tangible assets include deferred revenue fair value at acquisition date					276,000
Write-down of deferred revenue					$ 311,000
myClincalExchange [Member]
Business Acquisition [Line Items]
Consideration paid for acquisition in cash	$ 4,400,000
Acquisition-related transaction costs	100,000
myClincalExchange [Member] \| Recovery of Working Capital Adjustment and Certain Potential Indemnification Claims [Member]
Business Acquisition [Line Items]
Purchase price held in escrow	$ 400,000

Business Combinations - Summary of Purchase Price (Detail) - NurseGrid [Member] $ in Thousands	Mar. 09, 2020 USD ($)
Business Acquisition [Line Items]
Total consideration paid	$ 21,500
Cash acquired	(4,064)
Net consideration paid	21,454
Fair value of existing equity interest in NurseGrid	3,623
Net consideration paid	25,077
Cash Paid at Closing [Member]
Business Acquisition [Line Items]
Total consideration paid	25,485
Post-closing Adjustment, Net of Cash Received [Member]
Business Acquisition [Line Items]
Total consideration paid	$ 33

Business Combinations - Summary of Fair Value of Assets Acquired and Liabilities Assumed (Detail) - USD ($)	Dec. 31, 2020	Mar. 09, 2020	Dec. 31, 2019	Dec. 16, 2019	Jan. 10, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill	$ 178,440,000		$ 102,196,000			$ 86,144,000
NurseGrid [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net		$ 92,000
Prepaid and other current assets		155,000
Operating lease right-of-use assets		50,000
Deferred tax assets		2,121,000
Goodwill		21,085,000
Intangible assets		1,845,000
Accounts payable and accrued liabilities		(143,000)
Deferred revenue		(78,000)
Operating lease liabilities		(50,000)
Net assets acquired		25,077,000
Accounts payable and accrued liabilities		143,000
Net tangible assets include deferred revenue fair value at acquisition date		78,000
Operating lease liabilities		$ 50,000
Providigm, LLC [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net					$ 960,000
Prepaid and other current assets					847,000
Operating lease right-of-use assets					1,233,000
Deferred tax assets					104,000
Goodwill					11,395,000
Intangible assets					5,950,000
Accounts payable and accrued liabilities					(1,196,000)
Deferred revenue					(141,000)
Operating lease liabilities					(1,233,000)
Net assets acquired					18,018,000
Property and equipment					50,000
Other assets					49,000
Accounts payable and accrued liabilities					1,196,000
Net tangible assets include deferred revenue fair value at acquisition date					141,000
Operating lease liabilities					$ 1,233,000
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Accounts and unbilled receivable, net				$ 204,000
Prepaid and other current assets				3,000
Operating lease right-of-use assets				30,000
Deferred tax assets				70,000
Goodwill				4,661,000
Intangible assets				4,340,000
Accounts payable and accrued liabilities				(7,000)
Deferred revenue				(276,000)
Operating lease liabilities				(30,000)
Net assets acquired				8,995,000
Accounts payable and accrued liabilities				7,000
Net tangible assets include deferred revenue fair value at acquisition date				276,000
Operating lease liabilities				$ 30,000

Business Combinations - Summary of Components of Identifiable Intangible Assets and Estimated Useful Lives (Detail) - USD ($) $ in Thousands	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020	Dec. 16, 2019	Jan. 10, 2019
NurseGrid [Member]
Business Acquisition [Line Items]
Fair value			$ 1,845
ShiftWizard [Member]
Business Acquisition [Line Items]
Fair value		$ 12,660
ShiftWizard [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Useful life		1 year
ShiftWizard [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Useful life		5 years
ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Fair value	$ 32,440
Providigm, LLC [Member]
Business Acquisition [Line Items]
Fair value					$ 5,950
CredentialMyDoc [Member]
Business Acquisition [Line Items]
Fair value				$ 4,340
Customer Relationships [Member] \| NurseGrid [Member]
Business Acquisition [Line Items]
Fair value			$ 35
Useful life			8 years
Customer Relationships [Member] \| ShiftWizard [Member]
Business Acquisition [Line Items]
Fair value		$ 7,800
Useful life		18 years
Customer Relationships [Member] \| ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Fair value	$ 21,100
Customer Relationships [Member] \| ANSOSTM Staff Scheduling Application [Member] \| Minimum [Member]
Business Acquisition [Line Items]
Useful life	11 years
Customer Relationships [Member] \| ANSOSTM Staff Scheduling Application [Member] \| Maximum [Member]
Business Acquisition [Line Items]
Useful life	14 years
Customer Relationships [Member] \| Providigm, LLC [Member]
Business Acquisition [Line Items]
Fair value					$ 3,500
Useful life					12 years
Customer Relationships [Member] \| CredentialMyDoc [Member]
Business Acquisition [Line Items]
Fair value				$ 2,100
Useful life				9 years
Developed Technology [Member] \| NurseGrid [Member]
Business Acquisition [Line Items]
Fair value			$ 1,110
Useful life			5 years
Developed Technology [Member] \| ShiftWizard [Member]
Business Acquisition [Line Items]
Fair value		$ 4,050
Useful life		5 years
Developed Technology [Member] \| ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Fair value	$ 9,800
Useful life	5 years
Developed Technology [Member] \| Providigm, LLC [Member]
Business Acquisition [Line Items]
Fair value					$ 2,200
Useful life					5 years
Developed Technology [Member] \| CredentialMyDoc [Member]
Business Acquisition [Line Items]
Fair value				$ 2,100
Useful life				4 years
Non-Compete [Member] \| ShiftWizard [Member]
Business Acquisition [Line Items]
Fair value		$ 580
Non-Compete [Member] \| CredentialMyDoc [Member]
Business Acquisition [Line Items]
Fair value				$ 110
Useful life				5 years
Trade Name [Member] \| NurseGrid [Member]
Business Acquisition [Line Items]
Fair value			$ 700
Trade Name [Member] \| ShiftWizard [Member]
Business Acquisition [Line Items]
Fair value		$ 230
Useful life		5 years
Trade Name [Member] \| ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Fair value	$ 1,540
Useful life	10 years
Trade Name [Member] \| Providigm, LLC [Member]
Business Acquisition [Line Items]
Fair value					$ 250
Useful life					7 years
Trade Name [Member] \| CredentialMyDoc [Member]
Business Acquisition [Line Items]
Fair value				$ 30
Useful life				3 years

Business Combinations - Summary of Revenue and Operating Loss Included in Company's Condensed Consolidated Statement of Income since the Date of Acquisition (Detail) $ in Thousands	12 Months Ended
	Dec. 31, 2020 USD ($)
NurseGrid [Member]
Business Acquisition [Line Items]
Total revenues	$ 219
Operating loss	(2,650)
ShiftWizard [Member]
Business Acquisition [Line Items]
Total revenues	731
Operating loss	(553)
ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Total revenues	959
Operating loss	$ (469)

Business Combinations - Summary of Unaudited Pro Forma Financial Information (Detail) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
NurseGrid [Member]
Business Acquisition [Line Items]
Total revenues	$ 244,963	$ 255,566
Income from continuing operations	13,576	11,405
Net income	$ 13,576	$ 12,979
Net income per share - basic	$ 0.42	$ 0.40
Net income per share - diluted	$ 0.42	$ 0.40
ShiftWizard [Member]
Business Acquisition [Line Items]
Total revenues	$ 248,306	$ 257,042
Income from continuing operations	13,056	11,604
Net income	$ 13,056	$ 13,178
Net income per share - basic	$ 0.41	$ 0.41
Net income per share - diluted	$ 0.41	$ 0.41
ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Total revenues	$ 270,246	$ 278,491
Income from continuing operations	18,861	16,534
Net income	$ 18,861	$ 18,108
Net income per share - basic	$ 0.59	$ 0.56
Net income per share - diluted	$ 0.59	$ 0.56

Business Combinations - Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 02, 2020	Oct. 12, 2020	Dec. 31, 2019	Dec. 31, 2018
Business Acquisition [Line Items]
Goodwill	$ 178,440			$ 102,196	$ 86,144
ShiftWizard [Member]
Business Acquisition [Line Items]
Cash			$ 1,091
Accounts and unbilled receivable, net			1,041
Prepaid assets			108
Operating lease right-of-use assets			183
Property and equipment			50
Indemnification assets			464
Goodwill			19,307
Intangible assets			12,660
Accounts payable and accrued liabilities			(601)
Deferred revenue			(1,601)
Deferred tax liability			(1,559)
Operating lease liabilities			(183)
Indemnification liability			(464)
Net assets acquired			$ 30,496
ANSOSTM Staff Scheduling Application [Member]
Business Acquisition [Line Items]
Cash		$ 1,599
Accounts and unbilled receivable, net		11,421
Prepaid assets		481
Operating lease right-of-use assets		888
Property and equipment		66
Goodwill		35,258
Intangible assets		32,440
Accounts payable and accrued liabilities		(1,693)
Deferred revenue		(14,529)
Operating lease liabilities		(888)
Net assets acquired		67,981
Deferred tax assets		2,938
Indemnification asset		708
Uncertain tax position liability		$ (708)

Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Revenues, net:
Revenues, net	$ 244,826	$ 254,112	$ 231,616
Operating income:
Operating income	15,818	14,720	15,491
Workforce Solutions [Member]
Revenues, net:
Revenues, net	197,587	208,599	190,139
Provider Solutions [Member]
Revenues, net:
Revenues, net	47,239	45,513	41,477
Operating Segments [Member] \| Workforce Solutions [Member]
Revenues, net:
Revenues, net	197,587	208,599	190,139
Operating income:
Operating income	41,622	40,296	38,834
Operating Segments [Member] \| Provider Solutions [Member]
Revenues, net:
Revenues, net	47,239	45,513	41,477
Operating income:
Operating income	4,678	5,384	3,474
Unallocated [Member]
Operating income:
Operating income	$ (30,482)	$ (30,960)	$ (26,817)

- Definition

+ References

+ Details

Business Segments - Business Segment Information Based on Assets (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Segment Reporting Information [Line Items]
Total assets	$ 500,313	$ 489,544
Total purchases of long-lived assets	21,008	31,533	$ 25,431
Total depreciation and amortization	30,189	27,869	24,231
Total assets	500,313	489,544
Operating Segments [Member] \| Workforce Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	270,924	118,382
Total purchases of long-lived assets	17,586	14,972	12,820
Total depreciation and amortization	12,930	10,813	9,780
Total assets	270,924	118,382
Operating Segments [Member] \| Provider Solutions [Member]
Segment Reporting Information [Line Items]
Total assets	140,490	148,398
Total purchases of long-lived assets	2,849	2,959	5,240
Total depreciation and amortization	10,311	9,757	8,895
Total assets	140,490	148,398
Unallocated [Member]
Segment Reporting Information [Line Items]
Total assets	88,899	222,764
Total purchases of long-lived assets	573	13,602	7,191
Total depreciation and amortization	6,948	7,299	5,375
Total assets	$ 88,899	$ 222,764
Discontinued Operations [Member]
Segment Reporting Information [Line Items]
Total purchases of long-lived assets			180
Total depreciation and amortization			$ 181

Income Taxes - Schedule of Components of Earnings Before Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
United States	$ 17,719	$ 17,929	$ 16,575
Foreign	105
Earnings before income taxes	$ 17,824	$ 17,929	$ 16,575

Income Taxes - Summary of Provision for Income Taxes (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Current federal	$ (1,022)	$ 233	$ (79)
Current state	387	634	386
Current foreign	71
Deferred federal	3,830	2,717	2,661
Deferred state	467	149	356
Deferred foreign	(1)
Provision for income taxes	$ 3,732	$ 3,733	$ 3,324

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

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, 2020	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Federal tax provision at the statutory rate	$ 3,743	$ 3,765	$ 3,482
State income tax provision, net of federal benefit	787	895	658
Tax credits	(745)	(614)	(509)
Change in valuation allowance	4	(247)	2
Impact of foreign operations	7
Stock compensation	27	(117)	(560)
Other	(91)	51	251
Provision for income taxes	$ 3,732	$ 3,733	$ 3,324

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Income Taxes - Additional Information (Detail) - USD ($)	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Taxes Disclosure [Line Items]
Valuation allowance	$ 550,000	$ 64,000
Unrecognized tax benefits	317,000	317,000
Interest and penalties related to unrecognized tax benefits	20,000	$ 14,000
Excess tax expense related to stock based awards	27,000
Federal [Member]
Income Taxes Disclosure [Line Items]
Net operating loss carryforwards	13,200,000
State [Member]
Income Taxes Disclosure [Line Items]
Net operating loss carryforwards	23,200,000
Foreign [Member]
Income Taxes Disclosure [Line Items]
Net operating loss carryforwards	$ 200,000
Earliest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years	2021
Latest Tax Year [Member]
Income Taxes Disclosure [Line Items]
Loss carryforwards will expire in years	2041

Income Taxes - Reconciliation of the Beginning and Ending Liability for Gross Unrecognized Tax Benefits (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Balance at beginning of year	$ 317	$ 317
Additions for tax positions in the current year	0	0
Additions for tax positions of prior years	645
Balance at end of year	$ 962	$ 317

Income Taxes - Significant Components of Deferred Tax Assets and Deferred Tax Liabilities (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Deferred tax assets:
Allowance for doubtful accounts	$ 143	$ 215
Accrued liabilities	1,927	1,775
Lease liability	8,356	8,778
Tax credits	119
Stock based compensation	691	683
Deferred revenue	3,244	198
Basis difference on investments	395	381
Net operating loss carryforwards	3,692	263
Total deferred tax assets	18,567	12,293
Less: Valuation allowance	(550)	(64)
Deferred tax assets, net of valuation allowance	18,017	12,229
Deferred tax liabilities:
Deductible goodwill	2,614	2,236
Nondeductible intangible assets	3,752	801
Right of use assets	7,378	7,773
Prepaid assets	6,986	6,275
Capitalized software development	6,989	5,580
Depreciation	3,846	2,478
Total deferred tax liabilities	31,565	25,143
Net deferred tax liabilities	$ 13,548	$ 12,914

Stock Based Compensation - Additional Information (Detail)			1 Months Ended	3 Months Ended	12 Months Ended
	Jun. 30, 2019 shares	Jun. 26, 2019 USD ($) Employee shares	Jun. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Dec. 31, 2020 USD ($) $ / shares shares	Dec. 31, 2019 USD ($) shares	Dec. 31, 2018 USD ($)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock available for grant \| shares					626,000
Closing stock price \| $ / shares					$ 21.84
Weighted average remaining contractual term of options outstanding					10 years
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities					$ 435,000	$ 1,034,000	$ 338,000
Excess tax expense related to stock based awards					27,000
Stock based compensation expense					2,218,000	4,244,000	1,777,000
Payments related to employees' tax obligations to taxing authorities for stock awards						600,000
Employer tax and expenses for stock awards			$ 200,000
Chief Executive Officer, Robert A. Frist, Jr., [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares contributed to the company \| shares		78,520
Value of shares contributed to the company		$ 2,000,000.0
Number of additional shares contributed to the company \| shares	7,852
Stock Options and RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total unrecognized compensation expense related to non-vested stock options and RSUs					$ 4,300,000
Weighted average expense recognition period					2 years 7 months 6 days
RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate fair value of RSU awards that vested					$ 2,200,000	$ 1,900,000
Shares withheld for RSUs \| shares					19,000	15,000
Payments related to RSUs and stock options for the employees' tax obligations to taxing authorities					$ 400,000	$ 400,000	$ 300,000
2016 Omnibus Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vested \| shares		78,520
Number of employees awarded fully vested shares \| Employee		820
Stock based compensation expense				$ 2,000,000.0
Maximum [Member] \| Stock Options and RSUs [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of the options and RSU's granted					4 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, 2020 USD ($) $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	0
Granted, Common Shares \| shares	90
Exercised, Common Shares \| shares	0
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	90
Exercisable at end of period, Common Shares \| shares	0
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Granted, Weighted-Average Exercise Price \| $ / shares	20.34
Exercised, Weighted-Average Exercise Price \| $ / shares	0
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	20.34
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 135
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 0

Stock Based Compensation - Other Information Relative to Option Activity (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Total intrinsic value of stock options exercised	$ 277	$ 6,130
Cash proceeds from exercise of stock options	$ 214	$ 2,582

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, 2020 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Outstanding at beginning of period, shares \| shares	287
Granted \| shares	115
Vested \| shares	(90)
Forfeited \| shares	(13)
Outstanding at end of period, shares \| shares	299
Outstanding at beginning of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 25.61
Granted, Weighted-Average Grant Date Fair Value \| $ / shares	22.94
Vested, Weighted-Average Grant Date Fair Value \| $ / shares	24.53
Forfeited, Weighted-Average Grant Date Fair Value \| $ / shares	24.56
Outstanding at end of period, Weighted-Average Grant Date Fair Value \| $ / shares	$ 24.95
Aggregate intrinsic Value \| $	$ 6,526

Stock Based Compensation - Stock Based Compensation Expense Recorded in Consolidated Statements of Income (Detail) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 2,218	$ 4,244	$ 1,777
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	41	699	37
Product Development [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	363	956	296
Sales and Marketing [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	199	614	183
Other General and Administrative [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock based compensation expense	$ 1,615	$ 1,975	$ 1,261

Employee Benefit Plan - Additional Information (Detail) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018
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	$ 1.2	$ 1.4	$ 1.3

Discontinued Operations - Additional Information (Detail) - Patient Experience Solutions [Member] - USD ($) $ in Millions		12 Months Ended
	Feb. 12, 2018	Dec. 31, 2019	Dec. 31, 2018
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Consideration received	$ 65.2
Gain on sale of business, net of tax	$ 20.5	$ 1.5	$ 19.0

Debt - Additional Information (Detail)	12 Months Ended
Debt - Additional Information (Detail)	Dec. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)
Line of Credit Facility [Line Items]
Debt outstanding	$ 0	$ 0
Truist 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.
Truist Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.30%
Truist Bank [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Commitment fee paid per annum	0.20%
Revolving Credit Facility [Member] \| Truist Bank [Member]
Line of Credit Facility [Line Items]
Outstanding balance on revolving credit facility	$ 0
Revolving credit facility borrowings	$ 0
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Debt leverage ratio	300.00%
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Minimum [Member]
Line of Credit Facility [Line Items]
Interest coverage ratio	300.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member]
Line of Credit Facility [Line Items]
Maturity date of Loan agreement	Oct. 28, 2023
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 Truist’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 1.75%. The applicable margin for Base Rate loans depends on the Company’s funded debt leverage ratio and varies from 0.50% to 0.75%
Maximum borrowing capacity under credit facility	$ 65,000,000.0
Increase in revolving credit facility	25,000,000.0
Increase basket for dividend	65,000,000.0
Minimum liquidity amount	30,000,000.0
Minority owned investment	$ 20,000,000.0
Libor floor rate	0.50%
Principal payments prior to maturity	$ 0
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Swing Line Sub Facility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	5,000,000.0
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Letter of Credit Subfacility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity under credit facility	$ 5,000,000.0
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Federal Funds Effective Swap Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Line of Credit Facility, Interest Rate During Period	1.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member]
Line of Credit Facility [Line Items]
Leverage ratio	1.50
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	0.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Minimum [Member] \| Base Rate [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Minimum [Member] \| Eurodollar [Member]
Line of Credit Facility [Line Items]
Applicable margin for loans	1.50%

Leases - Additional Information (Detail) $ in Thousands	12 Months Ended
Leases - Additional Information (Detail) $ in Thousands	Dec. 31, 2020 USD ($) Lease	Dec. 31, 2019 USD ($)
Operating Leases Disclosure [Line Items]
Right-of-use assets	$ 28,081	$ 29,615
Operating lease, liability	$ 31,869	33,530
Operating leases that have not yet commenced \| Lease	0
Operating lease expense	$ 4,800	4,900
Cash paid for amounts included in the measurement of operating lease liabilities	$ 4,900	$ 2,500
Operating lease, weighted-average remaining lease term	9 years 7 months 6 days
Operating lease, weighted-average incremental borrowing rate	6.00%
NurseGrid [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	$ 1,100
Operating lease, liability	1,100
ShiftWizard [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	1,100
Operating lease, liability	1,100
ANSOSTM Staff Scheduling Application [Member]
Operating Leases Disclosure [Line Items]
Right-of-use assets	1,100
Operating lease, liability	$ 1,100

Leases - Schedule of Lease-Related Assets and Liabilities Recorded on Condensed Consolidated Balance Sheet (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease right of use assets, net	$ 28,081	$ 29,615
Operating lease liabilities, current	$ 3,390	$ 2,797
Operating lease, liability, current, statement of financial position [Extensible List]	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent	us-gaap:AccountsPayableAndAccruedLiabilitiesCurrent
Operating lease liability, non-current	$ 28,479	$ 30,733
Total operating lease liabilities	$ 31,869	$ 33,530

Leases - Schedule of Maturities of Lease Liabilities Under Non-Cancellable Leases (Detail) - USD ($) $ in Thousands	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
2021	$ 5,229
2022	4,430
2023	4,130
2024	4,176
2025	3,942
Thereafter	20,650
Total undiscounted lease payments	42,557
Less imputed interest	10,688
Total lease liabilities	$ 31,869	$ 33,530

Non-Marketable Equity Investments - Additional Information (Detail) - USD ($) $ in Thousands		12 Months Ended
	Mar. 09, 2020	Dec. 31, 2020	Dec. 31, 2018	Dec. 31, 2019
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Changes in adjustment to carrying value of non-marketable equity investment due to change in fair value		$ (1,181)	$ 1,271
Aggregate carrying amount of non-marketable equity investments		3,900		$ 5,900
Cumulative downward adjustments to carrying value of non-marketable equity investments		100
NurseGrid [Member]
Schedule Of Trading Securities And Other Trading Assets [Line Items]
Changes in adjustment to carrying value of non-marketable equity investment due to change in fair value	$ 1,200	$ (1,200)

Subsequent Event - Additional Information (Details) $ in Millions	Jan. 19, 2021 USD ($)
ProcessDATA, Ltd [Member] \| Subsequent Event [Member]
Subsequent Event [Line Items]
Total consideration paid	$ 2.0

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, 2020 USD ($) $ / shares shares
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Outstanding at beginning of period, Common Shares \| shares	0
Granted, Common Shares \| shares	90
Exercised, Common Shares \| shares	0
Expired, Common Shares \| shares	0
Forfeited, Common Shares \| shares	0
Outstanding at end of period, Common Shares \| shares	90
Exercisable at end of period, Common Shares \| shares	0
Outstanding at beginning of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Granted, Weighted-Average Exercise Price \| $ / shares	20.34
Exercised, Weighted-Average Exercise Price \| $ / shares	0
Expired, Weighted-Average Exercise Price \| $ / shares	0
Forfeited, Weighted-Average Exercise Price \| $ / shares	0
Outstanding at end of period, Weighted-Average Exercise Price \| $ / shares	20.34
Exercisable at end of period, Weighted-Average Exercise Price \| $ / shares	$ 0
Outstanding at end of period, Aggregate Intrinsic Value \| $	$ 135
Exercisable at end of period, Aggregate Intrinsic Value \| $	$ 0