0001437749-23-004908 | 10-K | XBRL Viewer

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Document And Entity Information - USD ($)	12 Months Ended
Document And Entity Information - USD ($)	Dec. 31, 2022	Feb. 20, 2023	Jun. 30, 2022
Document Information [Line Items]
Entity Central Index Key	0001095565
Entity Registrant Name	HEALTHSTREAM INC
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2022
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Document Transition Report	false
Entity File Number	000-27701
Entity Incorporation, State or Country Code	TN
Entity Tax Identification Number	62-1443555
Entity Address, Address Line One	500 11th Avenue North, Suite 1000
Entity Address, Postal Zip Code	37203
Entity Address, City or Town	Nashville
Entity Address, State or Province	TN
City Area Code	615
Local Phone Number	301-3100
Title of 12(b) Security	Common Stock (Par Value $0.00)
Trading Symbol	HSTM
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 523,400,000
Entity Common Stock, Shares Outstanding		30,582,194
Auditor Firm ID	42
Auditor Name	Ernst & Young LLP
Auditor Location	Nashville, Tennessee

Consolidated Balance Sheets - USD ($)
$ in Thousands

Dec. 31, 2022

Dec. 31, 2021

Current assets:

Cash and cash equivalents

$ 46,023

$ 46,905

Marketable securities

7,885

5,041

Accounts receivable, net of allowance of $544 and $853 at December 31, 2022 and 2021, respectively

36,730

30,308

Accounts receivable - unbilled

5,980

4,612

Prepaid royalties, net of amortization

9,071

9,155

Other prepaid expenses and other current assets

8,688

10,824

Total current assets

114,377

106,845

Property and equipment, net of accumulated depreciation of $20,280 and $17,999 at December 31, 2022 and 2021, respectively

15,483

17,950

Capitalized software development, net of accumulated amortization of $105,025 and $86,097 at December 31, 2022 and 2021, respectively

37,118

32,412

Operating lease right of use assets, net

22,759

25,168

Goodwill

192,398

182,501

Net

81,553

89,205

Deferred tax assets

383

601

Deferred commissions, net of amortization

28,344

24,012

Non-marketable equity investments

4,518

7,043

Other assets

808

1,016

Total assets

^[1]

497,741

486,753

Current liabilities:

Accounts payable

7,287

5,126

Accrued royalties

5,443

5,037

Accrued liabilities

25,014

16,371

Deferred revenue

79,469

73,816

Total current liabilities

117,213

100,350

Deferred tax liabilities

17,996

18,146

Deferred revenue, non-current

2,937

1,583

Operating lease liability, non-current

23,321

26,178

Other long-term liabilities

2,210

1,477

Commitments and contingencies

Shareholders’ equity:

Common stock, no par value, 75,000 shares authorized; 30,579 and 31,327 shares issued and outstanding at December 31, 2022 and 2021, respectively

254,832

270,791

Retained earnings

80,213

68,122

Accumulated other comprehensive (loss) income

(981)

106

Total shareholders’ equity

334,064

339,019

Total liabilities and shareholders’ equity

497,741

486,753

Current assets:

Net

61,269

68,803

Other Intangible Assets [Member]

Current assets:

Net

$ 20,284

$ 20,402

[1]

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.

Consolidated Balance Sheets (Parentheticals) - USD ($) shares in Thousands, $ / shares in Thousands, $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Accounts Receivable, Allowance for Credit Loss, Current	$ 544	$ 853
Accumulated amortization on property and equipment	20,280	17,999
Accumulated amortization on capitalized software development	105,025	86,097
Accumulated amortization on intangible assets	$ 61,370	$ 62,367
Common stock, shares authorized (in shares)	75,000	75,000
Common stock, shares issued (in shares)	30,579	31,327
Common stock, shares outstanding (in shares)	30,579	31,327
Common stock, par value (in dollars per share)	$ 0	$ 0
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 48,552	$ 45,615
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 12,818	$ 16,752

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues, net	$ 266,826	$ 256,712	$ 244,826
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	91,143	91,033	89,332
Product development	44,277	41,659	32,305
Sales and marketing	44,146	39,457	35,297
Other general and administrative expenses	36,866	39,695	41,885
Depreciation and amortization	37,945	36,813	30,189
Total operating costs and expenses	254,377	248,657	229,008
Operating income	12,449	8,055	15,818
Other income (loss), net	3,136	(289)	2,005
Income before income tax provision	15,585	7,766	17,823
Income tax provision	3,494	1,921	3,732
Net income	$ 12,091	$ 5,845	$ 14,091
Net income per share:
Basic (in dollars per share)	$ 0.39	$ 0.19	$ 0.44
Diluted (in dollars per share)	$ 0.39	$ 0.18	$ 0.44
Weighted average shares of common stock outstanding:
Basic (in shares)	30,648	31,534	31,960
Diluted (in shares)	30,717	31,618	31,989

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Net income	$ 12,091	$ 5,845	$ 14,091
Other comprehensive income, net of taxes:
Foreign currency translation adjustments	(1,091)	99	6
Unrealized gain (loss) on marketable securities	4	6	(9)
Total other comprehensive (loss) income	(1,087)	105	(3)
Comprehensive income	$ 11,004	$ 5,950	$ 14,088

- 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 ($) shares in Thousands, $ in Thousands	Common Stock Including Additional Paid in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balance (in shares) at Dec. 31, 2019	32,379
Balance at Dec. 31, 2019	$ 290,021	$ 48,143	$ 4	$ 338,168
Net income	0	14,091	0	14,091
Dividend forfeitures on unvested equity awards	0	43	0	43
Comprehensive income (loss)	0	0	(3)	(3)
Stock-based compensation	$ 2,217	0	0	2,217
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	71
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (435)	0	0	(435)
Repurchase of common stock (in shares)	(957)
Repurchase of common stock	$ (20,019)	0	0	(20,019)
Balance (in shares) at Dec. 31, 2020	31,493
Balance at Dec. 31, 2020	$ 271,784	62,277	1	334,062
Net income	0	5,845	0	5,845
Comprehensive income (loss)	0	0	105	105
Stock-based compensation	$ 5,303	0	0	5,303
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	131
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (1,182)	0	0	(1,182)
Repurchase of common stock (in shares)	(203)
Repurchase of common stock	$ (5,114)	0	0	(5,114)
Stock donated to Company (held in treasury) (in shares)	(94)
Stock donated to Company (held in treasury)	$ 0	0	0	$ 0
Balance (in shares) at Dec. 31, 2021	31,327			31,327
Balance at Dec. 31, 2021	$ 270,791	68,122	106	$ 339,019
Net income	0	12,091	0	12,091
Comprehensive income (loss)	0	0	(1,087)	(1,087)
Stock-based compensation	$ 3,554	0	0	3,554
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	95
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (565)	0	0	(565)
Repurchase of common stock (in shares)	(1,052)
Repurchase of common stock	$ (23,032)	0	0	(23,032)
Issuance of common stock in acquisition (in shares)	209
Issuance of common stock in acquisition	$ 4,084	0	0	$ 4,084
Balance (in shares) at Dec. 31, 2022	30,579			30,579
Balance at Dec. 31, 2022	$ 254,832	$ 80,213	$ (981)	$ 334,064

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
OPERATING ACTIVITIES:
Net income	$ 12,091	$ 5,845	$ 14,091
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	37,945	36,813	30,189
Stock-based compensation	3,554	5,303	2,217
Amortization of deferred commissions	10,599	9,169	8,768
Provision for credit losses	385	723	274
Deferred income taxes	710	1,539	4,295
(Gain) loss on disposal of fixed assets	(25)	21	0
Loss on equity method investments	747	462	51
Non-cash paid time off expense	0	(1,011)	0
Non-cash royalty expense	0	0	(3,440)
Change in fair value of non-marketable equity investments	(3,596)	(279)	(1,181)
Other	3	184	347
Changes in operating assets and liabilities:
Accounts and unbilled receivables	7,770	(10,344)	2,992
Prepaid royalties	84	416	2,397
Other prepaid expenses and other current assets	2,329	1,772	(2,985)
Deferred commissions	(14,931)	(13,274)	(11,030)
Other assets	208	52	(112)
Accounts payable and accrued expenses	3,742	(4,329)	1,124
Accrued royalties	406	(3,772)	(4,672)
Deferred revenue	4,707	(7,593)	(1,467)
Net cash provided by operating activities	51,188	42,385	35,874
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(3,965)	(4,705)	(121,342)
Proceeds from maturities of marketable securities	10,625	9,931	77,120
Proceeds from sales of marketable securities	0	0	15,051
Purchases of marketable securities	(13,467)	(5,223)	(61,179)
Proceeds from sale of fixed assets	26	0	0
Proceeds from sale of non-marketable equity investments	3,494	1,370	0
Payments to acquire non-marketable equity investments	0	(1,750)	(1,257)
Payments associated with capitalized software development	(23,334)	(21,929)	(16,815)
Purchases of property and equipment	(1,768)	(3,417)	(1,988)
Net cash used in investing activities	(28,389)	(25,723)	(110,410)
FINANCING ACTIVITIES:
Taxes paid related to net settlement of equity awards	(565)	(1,182)	(435)
Repurchases of common stock	(23,137)	(5,008)	(20,019)
Payment of cash dividends	0	(19)	(40)
Net cash used in financing activities	(23,702)	(6,209)	(20,494)
Effect of exchange rate changes on cash and cash equivalents	21	(114)	58
Net (decrease) increase in cash and cash equivalents	(882)	10,339	(94,972)
Cash and cash equivalents at beginning of period	46,905	36,566	131,538
Cash and cash equivalents at end of period	46,023	46,905	36,566
SUPPLEMENTAL CASH FLOW INFORMATION:
Interest paid	99	132	96
Income taxes paid (refunded)	718	(92)	877
Non-cash additions to non-marketable equity investments	$ 0	$ 0	$ 1,300

Note 1 - Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Significant Accounting Policies [Text Block]

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. The Company reports financial results generated through December 31, 2022 based on two reportable segments: Workforce Solutions and Provider Solutions, with Workforce Solutions products helping to meet the ongoing training, certification, assessment, development, and scheduling needs of the healthcare workforce, and Provider Solutions products offering healthcare organizations software applications for administering and tracking provider credentialing, privileging, and enrollment activities. As of January 2023, the Company's operations have been streamlined around its single platform strategy such that beginning January 1, 2023, the Company will cease having two reportable segments and will begin reporting on a one segment basis, as discussed in more detail in Note 9 - Business Segments.

Recently Adopted Accounting Standards

In October 2021, the Financial Accounting Standards Board issued Accounting Standards Update ("ASU") 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers. The new guidance requires contract assets and contract liabilities acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with Accounting Standards Codification 606, Revenue from Contracts with Customers, as if it had originated the contracts. This approach differs from the previous requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The standard is effective for the first interim period within annual reporting periods beginning after December 15, 2022 and early adoption is permitted. The Company early adopted this ASU on January 1, 2022, and the impact of the new standard is dependent on the magnitude of future acquisitions but has not had a material impact to date. The standard does not impact contract assets or liabilities from business combinations that occurred prior to the adoption date.

Recognition of Revenue

In accordance with Accounting Standards Codification 606, Revenue from Contracts with Customers, the Company's 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.

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 its 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 and onboarding services, consulting, and training. The majority of 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.

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. The Company generally determines 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 within the contract.

The Company receives payments from customers based on billing schedules established in its 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 credit losses, 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 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 due to credit-related factors 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 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 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 three years.

Prepaid Royalties

Prepaid royalties represent advance payments to business 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 prepaid royalties is included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

Allowance for Credit Losses

The Company estimates its allowance for credit losses 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. Expected credit losses are recorded under the caption other general and administrative expenses in the accompanying Consolidated Statements of Income.

Changes in the allowance for credit losses and the amounts charged to bad debt expense for the three years ended December 31, 2022 were as follows (in thousands):

Allowance Balance at Beginning of Period

Charged to Costs and Expenses

Write-offs

Allowance Balance at End of Period

2022
$ 853 $ 385 $ (694 ) $ 544

2021
549 723 (419 ) 853

2020
843 274 (568 ) 549

Capitalized Software and Content 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 development phase for projects to develop software and content. These assets are generally amortized using the straight-line method over three years. The Company capitalized $23.8 million and $21.4 million during 2022 and 2021, respectively. Amortization of capitalized software development was $18.9 million, $15.6 million, and $12.7 million during 2022, 2021, and 2020, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2022 and 2021, 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 may require significant judgments to be made by the Company. At December 31, 2022 and 2021, the Company's 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

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 carrying amount of its 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, the Company 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, 2022, 2021, or 2020.

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. As of December 31, 2022, 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 one and eighteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2022 was 11.5 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, 2022, 2021, or 2020.

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, 2022, 2021, or 2020.

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, and accrued liabilities. 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) and non-marketable equity investments, which are recorded under the equity method or under the measurement alternative (see Note 16 - Non-Marketable Equity Investments).

Advertising

The Company expenses the costs of advertising as incurred. Advertising expense for the years ended December 31, 2022, 2021, and 2020 was $1.9 million, $1.9 million, and $1.1 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, 2022, the Company had established a valuation allowance of $1.9 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 are excluded from the calculation of diluted weighted average shares outstanding.

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 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.

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 credit losses 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 or as of the years ended December 31, 2022, 2021, or 2020, respectively.

Stock-Based Compensation

As of December 31, 2022, the Company maintained two stock-based compensation plans under which awards are outstanding, as described in Note 11. The Company accounts for stock-based compensation using the fair-value based method for costs related to share-based payments, including stock options and restricted share units. The Company uses the Black Scholes option pricing model for calculating the fair value of option awards issued under its stock-based compensation plans. 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 or deficiencies from stock-based compensation if an excess tax benefit or deficiency is realized. Excess tax benefits and deficiencies are reflected in the Consolidated Statements of Income as a component of the provision for income taxes when realized.

Leases

The Company has several non-cancelable agreements to lease office space. For leases with a lease term greater than 12 months, the Company recognizes a right-of-use (ROU) asset and a lease liability on the balance sheet at the lease commencement date. Lease liabilities and their corresponding right-of-use assets are recorded based on the present value of the future lease payments over the expected lease term.

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. 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 adjustments included in accumulated other comprehensive income in the Consolidated Balance Sheets.

Note 2 - Shareholders' Equity

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Stockholders' Equity Note Disclosure [Text Block]

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, 2022 and 2021 was 30.6 million and 31.3 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. As of December 31, 2022 and 2021, there were no shares of preferred stock issued or outstanding.

Share Repurchase Plan

On November 30, 2021, the Company's Board of Directors authorized a share repurchase program to repurchase up to $20.0 million of the Company's outstanding shares of common stock. This share repurchase program concluded on March 8, 2022, when the maximum dollar amount authorized under the program was expended. Under this program, the Company repurchased a total of 853,023 shares through open market purchases at an aggregate value of $20.0 million, reflecting an average price per share of $23.45 (excluding the cost of broker commissions). During the year ended December 31, 2022, the Company repurchased 649,739 shares pursuant to this share repurchase program at an aggregate fair value of $14.9 million, based on an average price per share of $22.92 (excluding the cost of broker commissions).

On March 14, 2022, the Company's Board of Directors approved an expansion of the Company's share repurchase program by authorizing the repurchase of up to an additional $10.0 million of the Company's outstanding shares of common stock. The share repurchase expansion program is scheduled to terminate on the earlier of March 13, 2023, or when the maximum dollar amount has been expended. During the year ended December 31, 2022, the Company repurchased 402,050 shares at an aggregate fair value of $8.1 million, reflecting an average price per share of $20.19 (excluding the cost of broker commissions).

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Note 3 - Earnings Per Share

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Earnings Per Share [Text Block]

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, 2022 (in thousands, except per share amounts):

	*Year Ended December 31,*
	*2022*		*2021*		*2020*
Numerator:
Net income	$	12,091	$	5,845	$	14,091
Denominator:
Weighted-average shares outstanding		30,648		31,534		31,960
Effect of dilutive shares		69		84		29
Weighted-average diluted shares		30,717		31,618		31,989

Net income per share:
Basic	$	0.39	$	0.19	$	0.44
Diluted	$	0.39	$	0.18	$	0.44

Potentially dilutive shares representing 183,000, 78,000, and 122,000 shares of common stock for the years ended December 31, 2022, 2021, and 2020, respectively, were excluded from the calculation of diluted earnings per share because their effect would have been anti-dilutive.

Note 4 - Marketable Securities

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]

4. MARKETABLE SECURITIES

At December 31, 2022 and 2021, the fair value of marketable securities, which were all classified as available for sale, included the following (in thousands):

	*December 31, 2022*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*		*Fair Value*
Level 2:
U.S. government debt securities	$	7,882	$	3	$	—	$	7,885
Total	$	7,882	$	3	$	—	$	7,885

	December 31, 2021
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	5,043	$	—	$	(2	)	$	5,041
Total	$	5,043	$	—	$	(2	)	$	5,041

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, 2022 and 2021, the Company did not recognize any allowance for credit impairments on its available for sale debt securities. All investments in marketable securities are classified as current assets on the Consolidated Balance Sheets because the underlying securities mature within one year from the balance sheet date.

Note 5 - Revenue Recognition and Sales Commissions

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Revenue from Contract with Customer [Text Block]

5. REVENUE RECOGNITION AND SALES COMMISSIONS

Revenue Recognition

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 following table represents revenues disaggregated by revenue source for the three years ended December 31, 2022, 2021, and 2020 (in thousands). Sales taxes are excluded from revenues.

	*Year Ended December 31, 2022*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	207,191	$	46,769	$	253,960
Professional services		6,398		6,468		12,866
Total revenues, net	$	213,589	$	53,237	$	266,826

	*Year Ended December 31, 2021*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	199,676	$	43,941	$	243,617
Professional services		5,767		7,328		13,095
Total revenues, net	$	205,443	$	51,269	$	256,712

	*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

For the years ended December 31, 2022, 2021, and 2020, the Company recognized $0.4 million, $0.7 million, and $0.3 million, respectively, in impairment losses on receivables and contract assets arising from contracts with customers.

During the years ended December 31, 2022, 2021, and 2020, the Company recognized revenues of $71.4 million, $62.3 million, and $64.5 million, respectively, from amounts included in deferred revenue at the beginning of the respective period. As of December 31, 2022, $517 million of revenue is expected to be recognized from remaining performance obligations under contracts with customers. We expect to recognize revenue on approximately 44% of these remaining performance obligations over the 12 months ending December 31, 2023, with the remaining amounts recognized thereafter.

Sales Commissions

Sales commissions earned by our sales employees are considered incremental and recoverable costs of obtaining a contract with a customer. The Company recorded amortization of deferred commissions of $10.6 million, $9.2 million, and $8.8 million for the years ended December 31, 2022, 2021, and 2020, respectively, 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 https://asc.fasb.org/topic&trid=49130388

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
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Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Note 6 - Property and Equipment

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Property, Plant and Equipment Disclosure [Text Block]

6. PROPERTY AND EQUIPMENT

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

	*December 31,*
	*2022*			*2021*
Equipment	$	15,843		$	15,987
Leasehold improvements		14,937			14,937
Furniture and fixtures		4,983			5,025
Gross property and equipment		35,763			35,949
Accumulated depreciation and amortization		(20,280	)		(17,999	)
Property and equipment, net	$	15,483		$	17,950

Depreciation of property and equipment totaled $4.5 million, $6.3 million, and $6.9 million for the years ended December 31, 2022, 2021, and 2020, respectively.

Note 7 - Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Goodwill and Intangible Assets Disclosure [Text Block]

7. GOODWILL AND INTANGIBLE ASSETS

The changes in the carrying amount of goodwill for the years ended December 31, 2022 and 2021 are as follows (in thousands):

	*Workforce Solutions*			*Provider Solutions*		*Total*
Balance at January 1, 2022	$	108,077		$	74,424	$	182,501
Acquisition of CloudCME		6,819			—		6,819
Acquisition of eeds		3,568			—		3,568
Post-closing adjustment for ANSOS		267			—		267
Post-closing adjustment for ComplyALIGN		40			—		40
Post-closing adjustment for Rievent		46			—		46
Effect of exchange rate changes		(843	)		—		(843	)
Balance at December 31, 2022	$	117,974		$	74,424	$	192,398

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2021	$	104,016	$	74,424	$	178,440
Acquisition of ComplyALIGN		945		—		945
Acquisition of Rievent		1,707		—		1,707
Post-closing adjustment for ANSOS		1,183		—		1,183
Effect of exchange rate changes		226		—		226
Balance at December 31, 2021	$	108,077	$	74,424	$	182,501

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 eight to eighteen years, and other intangible assets consisting of developed technology, non-competition agreements, and trade names, which are amortized over their estimated useful lives ranging from one to ten years. The Company also recorded an indefinite lived intangible for a trade name valued at $0.7 million. However, in January 2023, the Company made a decision regarding the use of the indefinite lived trade name such that beginning in 2023, it will be amortized over a ten year remaining useful life and is therefore included in the future annual amortization expense table below. Amortization of intangible assets was $14.5 million, $14.9 million, and $10.5 million for the years ended December 31, 2022, 2021, and 2020, respectively.

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

	*As of December 31, 2022*							*As of December 31, 2021*
	*Gross Amount*		*Accumulated Amortization*			*Net*		*Gross Amount*		*Accumulated Amortization*			*Net*
Customer related	$	109,821	$	(48,552	)	$	61,269	$	114,418	$	(45,615	)	$	68,803
Other		33,102		(12,818	)		20,284		37,154		(16,752	)		20,402
Total	$	142,923	$	(61,370	)	$	81,553	$	151,572	$	(62,367	)	$	89,205

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

2023	$	14,823
2024		13,313
2025		12,550
2026		9,496
2027		8,712
Thereafter		22,659
Total	$	81,553

Note 8 - Business Combinations

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Business Combination Disclosure [Text Block]

8. BUSINESS COMBINATIONS

On January 19, 2021, the Company acquired the issued and outstanding equity of ProcessDATA, Ltd. (d/b/a ComplyALIGN and HospitalPORTAL) ("ComplyALIGN"), a Chicago, Illinois-based healthcare technology company offering SaaS-based policy management system for healthcare organizations, for $2.0 million in cash. 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. Net assets acquired were $2.0 million. Based on the fair value of assets acquired and liabilities assumed, including intangible assets of $1.0 million, goodwill of $1.0 million was established. 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 Workforce Solutions segment.

On December 1, 2021, the Company acquired substantially all of the assets of Rievent Technologies, LLC ("Rievent"), a Virginia Beach, Virginia-based healthcare technology company offering a SaaS-based continuing education (CME/CE) management and delivery application, branded Rievent, which supports publishers, professional associations, healthcare insurance companies, and healthcare providers, for $4.0 million in cash. 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. Net assets acquired were $4.0 million. Based on the fair value of assets acquired and liabilities assumed, including intangible assets of $2.4 million, goodwill of $1.8 million was established. The results of operations for Rievent are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

On May 18, 2022 , the Company acquired the remaining ownership interest (representing approximately 82% of the outstanding equity interests) of CloudCME, LLC ("CloudCME"), a Nashville-based healthcare technology company offering a SaaS-based application for managing all aspects of continuing education (CME/CE) within a healthcare organization, for approximately $4.0 million in cash and $4.1 million in shares of HealthStream's common stock issued through a private placement at closing. The Company previously held a minority interest in CloudCME of approximately 18%. 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. Net assets acquired were $9.6 million. Based on the fair value of assets acquired and liabilities assumed, including intangible assets of $3.8 million, goodwill of $6.8 million was established. The results of operations for CloudCME are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

On December 31, 2022, the Company acquired substantially all of the assets of Electronic Education Documentation System, LLC (d/b/a eeds) ("eeds"), an Asheville, North Carolina-based healthcare technology company offering a SaaS-based continuing education (CME/CE) management system for healthcare organizations, for approximately $6.6 million in cash, reflecting customary purchase price adjustments made to the purchase price paid of $7.0 million. The purchase price was included in accrued liabilities in the Company's Consolidated Balance Sheet as of December 31, 2022 and was paid in January 2023. Of the purchase price paid at closing, $0.6 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 preliminarily allocated the purchase consideration based on management’s estimates of fair value. Net assets acquired were $6.6 million. Based on the preliminary fair value of assets acquired and liabilities assumed, including intangible assets of $3.4 million, goodwill of $3.6 million was established. The results of operations for eeds are included in the Company’s Consolidated Financial Statements from the date of acquisition and are included in the Workforce Solutions segment.

Note 9 - Business Segments

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Segment Reporting Disclosure [Text Block]

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, 2022, 2021, and 2020 (in thousands).

Revenues, net:	*2022*		*2021*		*2020*
Workforce Solutions	$	213,589	$	205,443	$	197,587
Provider Solutions		53,237		51,269		47,239
Total revenues, net	$	266,826	$	256,712	$	244,826

Operating income:	*2022*			*2021*			*2020*
Workforce Solutions	$	35,498		$	31,736		$	41,622
Provider Solutions		6,857			7,915			4,678
Unallocated		(29,906	)		(31,596	)		(30,482	)
Total operating income	$	12,449		$	8,055		$	15,818

	Assets*				*Purchases of long-lived assets*						*Depreciation and amortization*
	*2022*		*2021*		*2022*		*2021*		*2020*		*2022*		*2021*		*2020*
Workforce Solutions	$	273,488	$	258,864	$	18,915	$	17,831	$	17,586	$	23,741	$	20,616	$	12,930
Provider Solutions		135,276		137,008		5,889		4,719		2,849		9,722		9,861		10,311
Unallocated		88,977		90,881		1,051		892		573		4,482		6,336		6,948
Total	$	497,741	$	486,753	$	25,855	$	23,442	$	21,008	$	37,945	$	36,813	$	30,189

* 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.

As described in greater detail earlier in this Annual Report on Form 10-K, the Company has been in the process of more completely unifying its business under a single platform strategy that is designed to serve as a foundation for the entire enterprise. As a result of this process, the Company’s business is now organized and managed around a consolidated, enterprise approach, including with regard to technology, operations, accounting, internal reporting, organizational structure, compensation, performance assessment, and resource allocation. As of January 2023, the Company’s shift to operate and organize itself on a consolidated, enterprise basis consistent with its single platform strategy reached an inflection point which has resulted in Workforce Solutions and Provider Solutions no longer existing as separate operating segments or separate reportable segments. As a result, beginning with the Quarterly Report on Form 10-Q to be filed for the three months ended March 31, 2023, the Company will report its financial performance as a single reportable segment.

As of January 2023, the Company has one operating segment. Operating segments are defined as components of an enterprise where separate financial information is evaluated regularly by a chief operating decision maker (CODM) in deciding how to allocate resources and assess performance. As of January 1, 2023, the Company’s CODM was our Chief Executive Officer, Robert A. Frist, Jr. The Company’s CODM now allocates resources and assesses performance based upon discrete financial information at the consolidated level. Discrete financial information to measure profitability is no longer being prepared at any other level.

- 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

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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+ Details

Note 10 - Income Taxes

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Income Tax Disclosure [Text Block]

10. INCOME TAXES

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

	*Year Ended December 31,*
	*2022*			*2021*			*2020*
United States	$	15,777		$	8,006		$	17,719
Foreign		(192	)		(240	)		104
Earnings before income taxes	$	15,585		$	7,766		$	17,823

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

	*Year Ended December 31,*
	*2022*			*2021*			*2020*
Current federal	$	1,972		$	5		$	(1,022	)
Current state		923			406			387
Current foreign		(110	)		(29	)		71
Deferred federal		495			926			3,830
Deferred state		239			699			467
Deferred foreign		(25	)		(86	)		(1	)
Provision for income taxes	$	3,494		$	1,921		$	3,732

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,*
	*2022*			*2021*			*2020*
Federal tax provision at the statutory rate	$	3,274		$	1,631		$	3,743
State income tax provision, net of federal benefit		975			1,297			787
Tax credits		(1,227	)		(717	)		(745	)
Change in valuation allowance		51			(272	)		4
Adjustments for prior year taxes		(261	)		(13	)		(94	)
Changes in uncertain tax positions		767			(10	)		20
Other		(85	)		5			17
Provision for income taxes	$	3,494		$	1,921		$	3,732

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, 2022, the Company has a valuation allowance of $1.9 million recorded against deferred tax assets for state net operating losses and certain foreign deferred tax assets.

As of December 31, 2022, the Company had federal, state, and foreign net operating loss carryforwards of $5.5 million, $15.2 million, and $8.4 million, respectively. Certain losses have an indefinite carryforward period, while other loss carryforwards will expire in years 2032 through 2042. A portion of the net operating loss carryforwards are subject to annual limitations under Internal Revenue Code Section 382. The annual limitations could result in the expiration 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. We are under examination by the Internal Revenue Service for the 2018 tax year, and have agreed to finalization of this examination and do not expect the adjustment to exceed the uncertain tax position previously recorded. The Company is no longer subject to U.S. federal tax examinations for tax years before 2018, and with few exceptions, the Company is not subject to examination by foreign or state tax authorities for tax years which ended before 2019. Loss carryforwards and credit carryforwards generated or utilized in years earlier than 2019 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,*
	*2022*			*2021*
Balance at beginning of year	$	300		$	962
Additions for tax positions in current year		743			—
Reductions for tax positions of prior years		(7	)		(662	)
Balance at end of year	$	1,036		$	300

Upon reaching the final determination of the 2018 IRS examination, which resulted in a reduction to the research & development tax credit for 2018, the Company evaluated its research & development credit realizability for all open tax years. Taking into consideration the subjectivity of this credit qualification, the Company increased the reserve for uncertain tax positions by $0.7 million during the current year.

The Company recognized $31,000 and $7,000 for interest and penalties related to unrecognized tax benefits within the provision for income taxes during the years ended December 31, 2022 and 2021, respectively. Unrecognized tax benefits included tax positions of $1.0 million and $0.3 million for the years ended December 31, 2022 and 2021, respectively, that if recognized would impact the Company’s effective tax rate.

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,*
	*2022*			*2021*
Deferred tax assets:
Allowance for credit losses	$	142		$	222
Accrued liabilities		1,111			1,827
Lease liability		6,896			7,548
Tax credits		362			518
Stock-based compensation		1,064			901
Deferred revenue		653			570
Basis difference on investments		—			300
Net operating loss carryforwards		4,069			7,210
Total deferred tax assets		14,297			19,096
Less: Valuation allowance		(1,947	)		(2,011	)
Deferred tax assets, net of valuation allowance		12,350			17,085
Deferred tax liabilities:
Deductible goodwill		5,691			4,906
Nondeductible intangible assets		2,878			3,422
Right of use assets		6,001			6,523
Prepaid assets		9,302			8,269
Capitalized software development		3,415			8,484
Depreciation		2,548			3,026
Basis difference on investments		128			—
Total deferred tax liabilities		29,963			34,630

Net deferred tax liabilities	$	17,613		$	17,545

The Company realized $97,000 of excess tax deficiencies related to stock-based awards during the year ended December 31, 2022, 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

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+ Details

Note 11 - Stock-based Compensation

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Share-Based Payment Arrangement [Text Block]

11. STOCK-BASED COMPENSATION

Stock Incentive Plan

The Company has outstanding stock-based awards under its 2016 Omnibus Incentive Plan (2016 Plan) and 2022 Omnibus Incentive Plan (2022 Plan) (collectively, the 2016 Plan and the 2022 Plan, referred to as the Plans). The 2022 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 2022 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 included annual vesting over a period of up to five years, generally beginning one year after the grant date. As of December 31, 2022, 1,254,309 shares of common stock were available to be granted under the 2022 Plan.

Stock Option Activity

A summary of activity relative to stock options for the year ended December 31, 2022 is as follows (in thousands, except weighted-average exercise price).

			*Weighted-*
	*Common*		*Average*		*Aggregate*
	*Shares*		*Exercise Price*		*Intrinsic Value*
Outstanding at beginning of period		90	$	20.34
Granted		—		—
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	405
Exercisable at end of period		32	$	20.34	$	142

The aggregate intrinsic value for stock options in the table above represents the total difference between the Company’s closing stock price on December 30, 2022 (the last trading day of the year) of $24.84 per share and the option exercise price, multiplied by the number of in-the money options as of December 31, 2022. The weighted average remaining contractual term of options outstanding at December 31, 2022 was 8 years.

Restricted Share Unit Activity

A summary of activity relative to RSUs for the year ended December 31, 2022 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		365		$	24.59
Granted		317			21.13
Vested		(123	)		25.00
Forfeited		(27	)		23.53
Outstanding at end of period		532		$	22.49	$	13,213

The aggregate fair value of RSUs that vested during the year ended December 31, 2022 and 2021, as of the respective vesting dates, was $3.1 million and $2.3 million, respectively. A portion of RSUs that vested in 2022 and 2021 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 taxes during 2022 and 2021 were 28,000 and 20,000, 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 $0.6 million in 2022, $0.5 million in 2021, and $0.4 million in 2020, 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,*
	*2022*		*2021*		*2020*
Cost of revenues (excluding depreciation and amortization)	$	155	$	944	$	41
Product development		608		1,164		363
Sales and marketing		239		759		199
Other general and administrative		2,552		2,436		1,614
Total stock-based compensation expense	$	3,554	$	5,303	$	2,217

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, 2022, total unrecognized compensation expense related to non-vested stock options and RSUs was $6.9 million, net of estimated forfeitures, with a weighted average expense recognition period remaining of 2.8 years. The Company realized $97,000 of excess tax deficiencies related to stock-based awards during the year ended December 31, 2022, which was reflected in the Consolidated Statement of Income as a component of the provision for income taxes.

Stock Awards

During December 2021, the Company’s Chief Executive Officer, Robert A. Frist, Jr., contributed 86,494 of his personally owned shares of HealthStream, Inc. common stock (valued at $2.25 million) to the Company, without any consideration paid to him, for the benefit of the Company’s employees. In connection therewith, effective December 29, 2021 the Company approved the award of 86,494 fully vested shares of common stock to over 1,000 employees of the Company under the HealthStream, Inc. 2016 Omnibus Incentive Plan. These shares were issued in December 2021. As required by ASC Topic 718, Compensation – Stock Compensation, ("ASC 718") the Company recognized $2.25 million of stock-based compensation expense for these stock awards during the three months ended December 31, 2021 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 $0.7 million and are reflected as a financing activity within the Consolidated Statement of Cash Flows for 2021. In addition, the employer taxes and expenses associated with these grants were $0.2 million and were recorded as an expense during December 2021. Mr. Frist contributed an additional 7,113 of his personally owned shares to cover these costs. The receipt of shares from Mr. Frist 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).

Note 12 - Employee Benefit Plan

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Retirement Benefits [Text Block]

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 $1.5 million, $2.0 million, and $1.2 million for the years ended December 31, 2022, 2021, and 2020, respectively.

- Definition

The entire disclosure for retirement benefits.

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+ Details

Note 13 - Debt

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Debt Disclosure [Text Block]

13. DEBT

At December 31, 2022 and 2021, 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 Revolving Credit 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, 2022, the Company was in compliance with all covenants. There were no balances outstanding on the Revolving Credit Facility as of December 31, 2022 and there were no borrowings under the Revolving Credit Facility during the year ended December 31, 2022.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Note 14 - Leases

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Lessee, Operating Leases [Text Block]

14. LEASES

The Company’s operating lease expense as presented in other general and administrative expense in the Consolidated Statements of Income was $4.3 million, $5.5 million, and $4.8 million for the twelve months ended December 31, 2022, 2021, and 2020, respectively. Cash paid for amounts included in the measurement of operating lease liabilities was $4.7 million and $5.3 million for the years ended December 31, 2022 and 2021, respectively. As of December 31, 2022, the weighted-average remaining lease term was 8.1 years, and the weighted-average incremental borrowing rate was 6%. As of December 31, 2022, the Company did not have any leases that had not yet commenced.

The table below presents the lease-related assets and liabilities recorded on the Consolidated Balance Sheets as of December 31, 2022 and 2021 (in thousands).

		*Year Ended December 31,*
		*2022*		*2021*
Assets	*Classification*
Operating lease right-of-use assets	Operating lease right of use assets, net	$	22,759	$	25,168
Total leased assets		$	22,759	$	25,168
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,840	$	2,928
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		23,321		26,178
Total operating lease liabilities		$	26,161	$	29,106

The table below presents the maturities of lease liabilities under non-cancellable leases as of December 31, 2022 (in thousands).

2023	$	4,347
2024		4,401
2025		4,022
2026		3,650
2027		3,385
Thereafter		13,616
Total undiscounted lease payments	$	33,421
Less imputed interest		(7,260	)
Total lease liabilities	$	26,161

The Company subleases certain of its office space included above under non-cancellable leases and is due to receive future minimum rental payments of approximately $0.2 million, $0.2 million, and $37,000 for the years ended December 31, 2023, 2024, and 2025, respectively.

Note 15 - Litigation

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Commitments and Contingencies Disclosure [Text Block]

15. 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.

Note 16 - Non-marketable Equity Investments

12 Months Ended

Dec. 31, 2022

Notes to Financial Statements

Non-marketable Equity Investments Disclosure [Text Block]

16. 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 $1.5 million and $2.8 million for the years ended December 31, 2022 and 2021, respectively, which we evaluate for impairment at each reporting period. During the year ended December 31, 2022, the Company recorded a $2.7 million upward adjustment to the carrying value of a non-marketable equity investment due to a change in fair value based on the consideration received upon the sale of the investment. During the year ended December 31, 2021, the Company recorded a $0.3 million upward adjustment to the carrying value of a non-marketable equity investment due to a change in fair value based on the consideration received upon the sale of the investment. Cumulatively, the Company has recorded $2.8 million in upward adjustments to the carrying value of non-marketable equity investments. Such is the combination of cumulative upward adjustments of $4.1 million offset by cumulative downward adjustments of $1.3 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.

Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2022

Accounting Policies [Abstract]

Business Description [Policy Text Block]

Description of Business

HealthStream, Inc. (the "Company") was incorporated in 1990 as a Tennessee corporation and is headquartered in Nashville, Tennessee. The Company reports financial results generated through December 31, 2022 based on two reportable segments: Workforce Solutions and Provider Solutions, with Workforce Solutions products helping to meet the ongoing training, certification, assessment, development, and scheduling needs of the healthcare workforce, and Provider Solutions products offering healthcare organizations software applications for administering and tracking provider credentialing, privileging, and enrollment activities. As of January 2023, the Company's operations have been streamlined around its single platform strategy such that beginning January 1, 2023, the Company will cease having two reportable segments and will begin reporting on a one segment basis, as discussed in more detail in Note 9 - Business Segments.

New Accounting Pronouncements, Policy [Policy Text Block]

Recently Adopted Accounting Standards

In October 2021, the Financial Accounting Standards Board issued Accounting Standards Update ("ASU") 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers. The new guidance requires contract assets and contract liabilities acquired in a business combination to be recognized and measured by the acquirer on the acquisition date in accordance with Accounting Standards Codification 606, Revenue from Contracts with Customers, as if it had originated the contracts. This approach differs from the previous requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The standard is effective for the first interim period within annual reporting periods beginning after December 15, 2022 and early adoption is permitted. The Company early adopted this ASU on January 1, 2022, and the impact of the new standard is dependent on the magnitude of future acquisitions but has not had a material impact to date. The standard does not impact contract assets or liabilities from business combinations that occurred prior to the adoption date.

Revenue from Contract with Customer [Policy Text Block]

Recognition of Revenue

In accordance with Accounting Standards Codification 606, Revenue from Contracts with Customers, the Company's 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.

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 its 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 and onboarding services, consulting, and training. The majority of 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.

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. The Company generally determines 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 within the contract.

The Company receives payments from customers based on billing schedules established in its 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 credit losses, 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 satisfaction of performance obligations.

Basis of Accounting, Policy [Policy Text Block]

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, Policy [Policy Text Block]

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 and Cash Equivalents, Policy [Policy Text Block]

Cash Equivalents

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

Marketable Securities, Policy [Policy Text Block]

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 due to credit-related factors 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.

Revenue from Contract with Customer Commissions Policy [Policy Text Block]

Deferred Commissions

Deferred commissions represent incremental costs to acquire contracts with customers, such as the 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 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 three years.

Deferred Charges, Policy [Policy Text Block]

Prepaid Royalties

Prepaid royalties represent advance payments to business 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 prepaid royalties is included under the caption cost of revenues (excluding depreciation and amortization) in the accompanying Consolidated Statements of Income.

Receivables, Trade and Other Accounts Receivable, Allowance for Doubtful Accounts, Policy [Policy Text Block]

Allowance for Credit Losses

The Company estimates its allowance for credit losses 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. Expected credit losses are recorded under the caption other general and administrative expenses in the accompanying Consolidated Statements of Income.

Changes in the allowance for credit losses and the amounts charged to bad debt expense for the three years ended December 31, 2022 were as follows (in thousands):

	*Allowance Balance at Beginning of Period*		*Charged to Costs and Expenses*		*Write-offs*			*Allowance Balance at End of Period*
2022	$	853	$	385	$	(694	)	$	544
2021		549		723		(419	)		853
2020		843		274		(568	)		549

Research, Development, and Computer Software, Policy [Policy Text Block]

Capitalized Software and Content 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 development phase for projects to develop software and content. These assets are generally amortized using the straight-line method over three years. The Company capitalized $23.8 million and $21.4 million during 2022 and 2021, respectively. Amortization of capitalized software development was $18.9 million, $15.6 million, and $12.7 million during 2022, 2021, and 2020, respectively. Maintenance and operating costs are expensed as incurred. As of December 31, 2022 and 2021, there were no capitalized software development costs for external computer software developed for resale.

Fair Value Measurement, Policy [Policy Text Block]

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 may require significant judgments to be made by the Company. At December 31, 2022 and 2021, the Company's 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, Plant and Equipment, Policy [Policy Text Block]

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, Policy [Policy Text Block]

Goodwill

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 carrying amount of its 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, the Company 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, 2022, 2021, or 2020.

Goodwill and Intangible Assets, Intangible Assets, Policy [Policy Text Block]

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. As of December 31, 2022, 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 one and eighteen years. The weighted average amortization period for definite lived intangible assets as of December 31, 2022 was 11.5 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, 2022, 2021, or 2020.

Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]

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, 2022, 2021, or 2020.

Equity Securities without Readily Determinable Fair Value [Policy Text Block]

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.

Fair Value of Financial Instruments, Policy [Policy Text Block]

Financial Instruments

The Company has various financial instruments, including cash and cash equivalents, accounts receivable, accounts receivable-unbilled, accounts payable, and accrued liabilities. 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) and non-marketable equity investments, which are recorded under the equity method or under the measurement alternative (see Note 16 - Non-Marketable Equity Investments).

Advertising Cost [Policy Text Block]

Advertising

The Company expenses the costs of advertising as incurred. Advertising expense for the years ended December 31, 2022, 2021, and 2020 was $1.9 million, $1.9 million, and $1.1 million, respectively, and is included under the caption sales and marketing expense in the accompanying Consolidated Statements of Income.

Shipping and Handling Costs Policy [Policy Text Block]

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 Tax, Policy [Policy Text Block]

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, 2022, the Company had established a valuation allowance of $1.9 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, Policy [Policy Text Block]

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 are excluded from the calculation of diluted weighted average shares outstanding.

Concentration Risk, Credit Risk, Policy [Policy Text Block]

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 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.

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 credit losses 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 or as of the years ended December 31, 2022, 2021, or 2020, respectively.

Share-Based Payment Arrangement [Policy Text Block]

Stock-Based Compensation

As of December 31, 2022, the Company maintained two stock-based compensation plans under which awards are outstanding, as described in Note 11. The Company accounts for stock-based compensation using the fair-value based method for costs related to share-based payments, including stock options and restricted share units. The Company uses the Black Scholes option pricing model for calculating the fair value of option awards issued under its stock-based compensation plans. 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 or deficiencies from stock-based compensation if an excess tax benefit or deficiency is realized. Excess tax benefits and deficiencies are reflected in the Consolidated Statements of Income as a component of the provision for income taxes when realized.

Lessee, Leases [Policy Text Block]

Leases

The Company has several non-cancelable agreements to lease office space. For leases with a lease term greater than 12 months, the Company recognizes a right-of-use (ROU) asset and a lease liability on the balance sheet at the lease commencement date. Lease liabilities and their corresponding right-of-use assets are recorded based on the present value of the future lease payments over the expected lease term.

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. 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 Transactions and Translations Policy [Policy Text Block]

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 adjustments included in accumulated other comprehensive income in the Consolidated Balance Sheets.

Note 1 - Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Financing Receivable, Allowance for Credit Loss [Table Text Block]

	*Allowance Balance at Beginning of Period*		*Charged to Costs and Expenses*		*Write-offs*			*Allowance Balance at End of Period*
2022	$	853	$	385	$	(694	)	$	544
2021		549		723		(419	)		853
2020		843		274		(568	)		549

Property Plant and Equipment Useful Lives [Table Text Block]

	*Years*
Furniture and fixtures		5 - 7
Equipment		3

Note 3 - Earnings Per Share (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]

	*Year Ended December 31,*
	*2022*		*2021*		*2020*
Numerator:
Net income	$	12,091	$	5,845	$	14,091
Denominator:
Weighted-average shares outstanding		30,648		31,534		31,960
Effect of dilutive shares		69		84		29
Weighted-average diluted shares		30,717		31,618		31,989

Net income per share:
Basic	$	0.39	$	0.19	$	0.44
Diluted	$	0.39	$	0.18	$	0.44

Note 4 - Marketable Securities (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Debt Securities, Available-for-Sale [Table Text Block]

	*December 31, 2022*
	*Adjusted Cost*		*Unrealized Gains*		*Unrealized Losses*		*Fair Value*
Level 2:
U.S. government debt securities	$	7,882	$	3	$	—	$	7,885
Total	$	7,882	$	3	$	—	$	7,885

	December 31, 2021
	Adjusted Cost		Unrealized Gains		Unrealized Losses			Fair Value
Level 2:
Corporate debt securities	$	5,043	$	—	$	(2	)	$	5,041
Total	$	5,043	$	—	$	(2	)	$	5,041

Note 5 - Revenue Recognition and Sales Commissions (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Disaggregation of Revenue [Table Text Block]

	*Year Ended December 31, 2022*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	207,191	$	46,769	$	253,960
Professional services		6,398		6,468		12,866
Total revenues, net	$	213,589	$	53,237	$	266,826

	*Year Ended December 31, 2021*
Business Segments	*Workforce Solutions*		*Provider Solutions*		*Consolidated*
Subscription services	$	199,676	$	43,941	$	243,617
Professional services		5,767		7,328		13,095
Total revenues, net	$	205,443	$	51,269	$	256,712

	*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

Note 6 - Property and Equipment (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Property, Plant and Equipment [Table Text Block]

	*December 31,*
	*2022*			*2021*
Equipment	$	15,843		$	15,987
Leasehold improvements		14,937			14,937
Furniture and fixtures		4,983			5,025
Gross property and equipment		35,763			35,949
Accumulated depreciation and amortization		(20,280	)		(17,999	)
Property and equipment, net	$	15,483		$	17,950

Note 7 - Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Schedule of Goodwill [Table Text Block]

	*Workforce Solutions*			*Provider Solutions*		*Total*
Balance at January 1, 2022	$	108,077		$	74,424	$	182,501
Acquisition of CloudCME		6,819			—		6,819
Acquisition of eeds		3,568			—		3,568
Post-closing adjustment for ANSOS		267			—		267
Post-closing adjustment for ComplyALIGN		40			—		40
Post-closing adjustment for Rievent		46			—		46
Effect of exchange rate changes		(843	)		—		(843	)
Balance at December 31, 2022	$	117,974		$	74,424	$	192,398

	*Workforce Solutions*		*Provider Solutions*		*Total*
Balance at January 1, 2021	$	104,016	$	74,424	$	178,440
Acquisition of ComplyALIGN		945		—		945
Acquisition of Rievent		1,707		—		1,707
Post-closing adjustment for ANSOS		1,183		—		1,183
Effect of exchange rate changes		226		—		226
Balance at December 31, 2021	$	108,077	$	74,424	$	182,501

Schedule of Finite-Lived Intangible Assets [Table Text Block]

	*As of December 31, 2022*							*As of December 31, 2021*
	*Gross Amount*		*Accumulated Amortization*			*Net*		*Gross Amount*		*Accumulated Amortization*			*Net*
Customer related	$	109,821	$	(48,552	)	$	61,269	$	114,418	$	(45,615	)	$	68,803
Other		33,102		(12,818	)		20,284		37,154		(16,752	)		20,402
Total	$	142,923	$	(61,370	)	$	81,553	$	151,572	$	(62,367	)	$	89,205

Schedule of Finite-Lived Intangible Assets, Future Amortization Expense [Table Text Block]

2023	$	14,823
2024		13,313
2025		12,550
2026		9,496
2027		8,712
Thereafter		22,659
Total	$	81,553

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef
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-Name Accounting Standards Codification
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Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
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-Paragraph 1
-Subparagraph (g)
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Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

Note 9 - Business Segments (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Reconciliation of Revenue and Operating Profit Loss from Segments to Consolidated [Table Text Block]

Revenues, net:	*2022*		*2021*		*2020*
Workforce Solutions	$	213,589	$	205,443	$	197,587
Provider Solutions		53,237		51,269		47,239
Total revenues, net	$	266,826	$	256,712	$	244,826

Operating income:	*2022*			*2021*			*2020*
Workforce Solutions	$	35,498		$	31,736		$	41,622
Provider Solutions		6,857			7,915			4,678
Unallocated		(29,906	)		(31,596	)		(30,482	)
Total operating income	$	12,449		$	8,055		$	15,818

Reconciliation of Assets from Segment to Consolidated [Table Text Block]

	Assets*				*Purchases of long-lived assets*						*Depreciation and amortization*
	*2022*		*2021*		*2022*		*2021*		*2020*		*2022*		*2021*		*2020*
Workforce Solutions	$	273,488	$	258,864	$	18,915	$	17,831	$	17,586	$	23,741	$	20,616	$	12,930
Provider Solutions		135,276		137,008		5,889		4,719		2,849		9,722		9,861		10,311
Unallocated		88,977		90,881		1,051		892		573		4,482		6,336		6,948
Total	$	497,741	$	486,753	$	25,855	$	23,442	$	21,008	$	37,945	$	36,813	$	30,189

Note 10 - Income Taxes (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Schedule of Income before Income Tax, Domestic and Foreign [Table Text Block]

	*Year Ended December 31,*
	*2022*			*2021*			*2020*
United States	$	15,777		$	8,006		$	17,719
Foreign		(192	)		(240	)		104
Earnings before income taxes	$	15,585		$	7,766		$	17,823

Schedule of Components of Income Tax Expense (Benefit) [Table Text Block]

	*Year Ended December 31,*
	*2022*			*2021*			*2020*
Current federal	$	1,972		$	5		$	(1,022	)
Current state		923			406			387
Current foreign		(110	)		(29	)		71
Deferred federal		495			926			3,830
Deferred state		239			699			467
Deferred foreign		(25	)		(86	)		(1	)
Provision for income taxes	$	3,494		$	1,921		$	3,732

Schedule of Effective Income Tax Rate Reconciliation [Table Text Block]

	*Year Ended December 31,*
	*2022*			*2021*			*2020*
Federal tax provision at the statutory rate	$	3,274		$	1,631		$	3,743
State income tax provision, net of federal benefit		975			1,297			787
Tax credits		(1,227	)		(717	)		(745	)
Change in valuation allowance		51			(272	)		4
Adjustments for prior year taxes		(261	)		(13	)		(94	)
Changes in uncertain tax positions		767			(10	)		20
Other		(85	)		5			17
Provision for income taxes	$	3,494		$	1,921		$	3,732

Summary of Income Tax Contingencies [Table Text Block]

	*December 31,*
	*2022*			*2021*
Balance at beginning of year	$	300		$	962
Additions for tax positions in current year		743			—
Reductions for tax positions of prior years		(7	)		(662	)
Balance at end of year	$	1,036		$	300

Schedule of Deferred Tax Assets and Liabilities [Table Text Block]

	*December 31,*
	*2022*			*2021*
Deferred tax assets:
Allowance for credit losses	$	142		$	222
Accrued liabilities		1,111			1,827
Lease liability		6,896			7,548
Tax credits		362			518
Stock-based compensation		1,064			901
Deferred revenue		653			570
Basis difference on investments		—			300
Net operating loss carryforwards		4,069			7,210
Total deferred tax assets		14,297			19,096
Less: Valuation allowance		(1,947	)		(2,011	)
Deferred tax assets, net of valuation allowance		12,350			17,085
Deferred tax liabilities:
Deductible goodwill		5,691			4,906
Nondeductible intangible assets		2,878			3,422
Right of use assets		6,001			6,523
Prepaid assets		9,302			8,269
Capitalized software development		3,415			8,484
Depreciation		2,548			3,026
Basis difference on investments		128			—
Total deferred tax liabilities		29,963			34,630

Net deferred tax liabilities	$	17,613		$	17,545

Note 11 - Stock-based Compensation (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Share-Based Payment Arrangement, Option, Activity [Table Text Block]

			*Weighted-*
	*Common*		*Average*		*Aggregate*
	*Shares*		*Exercise Price*		*Intrinsic Value*
Outstanding at beginning of period		90	$	20.34
Granted		—		—
Exercised		—		—
Expired		—		—
Forfeited		—		—
Outstanding at end of period		90	$	20.34	$	405
Exercisable at end of period		32	$	20.34	$	142

Share-Based Payment Arrangement, Restricted Stock Unit, Activity [Table Text Block]

				*Weighted-*
	*Number of*			*Average Grant Date*		*Aggregate*
	*RSU’s*			*Fair Value*		*Intrinsic Value*
Outstanding at beginning of period		365		$	24.59
Granted		317			21.13
Vested		(123	)		25.00
Forfeited		(27	)		23.53
Outstanding at end of period		532		$	22.49	$	13,213

Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Table Text Block]

	*Years Ended December 31,*
	*2022*		*2021*		*2020*
Cost of revenues (excluding depreciation and amortization)	$	155	$	944	$	41
Product development		608		1,164		363
Sales and marketing		239		759		199
Other general and administrative		2,552		2,436		1,614
Total stock-based compensation expense	$	3,554	$	5,303	$	2,217

Note 14 - Leases (Tables)

12 Months Ended

Dec. 31, 2022

Notes Tables

Lessee, Operating Lease, Assets and Liabilities [Table Text Block]

		*Year Ended December 31,*
		*2022*		*2021*
Assets	*Classification*
Operating lease right-of-use assets	Operating lease right of use assets, net	$	22,759	$	25,168
Total leased assets		$	22,759	$	25,168
Liabilities
Operating lease liabilities, current	Accounts payable and accrued expenses	$	2,840	$	2,928
Operating lease liabilities, noncurrent	Operating lease liability, noncurrent		23,321		26,178
Total operating lease liabilities		$	26,161	$	29,106

Lessee, Operating Lease, Liability, Maturity [Table Text Block]

2023	$	4,347
2024		4,401
2025		4,022
2026		3,650
2027		3,385
Thereafter		13,616
Total undiscounted lease payments	$	33,421
Less imputed interest		(7,260	)
Total lease liabilities	$	26,161

Note 1 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands		12 Months Ended
	Jan. 01, 2023	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Number of Operating Segments		2
Capitalized Software Development Amortization Period (Year)		3 years
Capitalized Computer Software, Gross		$ 23,800	$ 21,400
Capitalized Computer Software, Amortization		18,900	15,600	$ 12,700
Capitalized Software Development Costs for Software Sold to Customers		0	0
Impairment of Intangible Assets, Finite-Lived		0	0	0
Impairment, Long-Lived Asset, Held-for-Use, Total		$ 0	0	0
Number of Possible Sources of Taxable Income		4
Deferred Tax Assets, Valuation Allowance		$ 1,947	2,011
Selling and Marketing Expense [Member]
Advertising Expense		$ 1,900	$ 1,900	$ 1,100
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		1 year
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		18 years
Weighted Average [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		11 years 6 months
Subsequent Event [Member]
Number of Operating Segments	1

Note 1 - Summary of Significant Accounting Policies - Changes in the Allowance for Doubtful Accounts and the Amounts Charged to Bad Debt Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Allowance balance	$ 853	$ 549	$ 843
Accounts Receivable, Credit Loss Expense (Reversal)	385	723	274
Write-offs	(694)	(419)	(568)
Allowance balance	$ 544	$ 853	$ 549

Note 1 - Summary of Significant Accounting Policies - Estimated Useful Lives of Property and Equipment (Details)	12 Months Ended
	Dec. 31, 2022
Equipment [Member]
Property and equipment, estimated useful lives (Year)	3 years
Minimum [Member] \| Furniture and Fixtures [Member]
Property and equipment, estimated useful lives (Year)	5 years
Maximum [Member] \| Furniture and Fixtures [Member]
Property and equipment, estimated useful lives (Year)	7 years

Note 2 - Shareholders' Equity (Details Textual) - USD ($) $ / shares in Units, $ in Thousands		12 Months Ended
	Nov. 30, 2021	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020	Mar. 14, 2022
Common Stock, Shares Authorized (in shares)		75,000,000	75,000,000
Common Stock, Shares, Outstanding, Ending Balance (in shares)		30,579,000	31,327,000
Common Stock, Shares, Issued (in shares)		30,579,000	31,327,000
Preferred Stock, Shares Authorized (in shares)		10,000,000
Stock Repurchased During Period, Value		$ 23,032	$ 5,114	$ 20,019
March 2020 Share Repurchase Program [Member]
Stock Repurchased During Period, Shares (in shares)		0	0
November 2021 Share Repurchase Program [Member]
Stock Repurchased During Period, Shares (in shares)	853,023	649,739
Stock Repurchase Program, Authorized Amount	$ 20,000
Stock Repurchased During Period, Value	$ 20,000	$ 14,900
Stock Repurchased Average Price per Share (in dollars per share)	$ 23.45	$ 22.92
March 2022 Share Repurchase Program [Member]
Stock Repurchased During Period, Shares (in shares)		402,050
Stock Repurchase Program, Authorized Amount					$ 10,000
Stock Repurchased During Period, Value		$ 8,100
Stock Repurchased Average Price per Share (in dollars per share)		$ 20.19

Note 3 - Earnings Per Share (Details Textual) - shares	12 Months Ended
Note 3 - Earnings Per Share (Details Textual) - shares	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	183,000	78,000	122,000

Note 3 - Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Net income	$ 12,091	$ 5,845	$ 14,091
Weighted-average shares outstanding (in shares)	30,648	31,534	31,960
Effect of dilutive shares (in shares)	69	84	29
Weighted-average diluted shares (in shares)	30,717	31,618	31,989
Net income per share:
Basic (in dollars per share)	$ 0.39	$ 0.19	$ 0.44
Diluted (in dollars per share)	$ 0.39	$ 0.18	$ 0.44

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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+ Details

- Definition

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

+ References

+ Details

Note 4 - Marketable Securities (Details Textual) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Other-than-temporary Impairment Loss, Debt Securities, Available-for-Sale	$ 0	$ 0

Note 4 - Marketable Securities - Fair Value of Available for Sale Marketable Securities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Adjusted Cost	$ 7,882	$ 5,043
Unrealized Gains	3	0
Unrealized Losses	0	(2)
Fair Value	7,885	5,041
Corporate Debt Securities [Member] \| Fair Value, Inputs, Level 2 [Member]
Adjusted Cost		5,043
Unrealized Gains		0
Unrealized Losses		(2)
Fair Value		$ 5,041
US Government Debt Securities [Member] \| Fair Value, Inputs, Level 2 [Member]
Adjusted Cost	7,882
Unrealized Gains	3
Unrealized Losses	0
Fair Value	$ 7,885

Note 5 - Revenue Recognition and Sales Commissions 1 (Details Textual) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Accounts Receivable, Credit Loss Expense (Reversal)	$ 385	$ 723	$ 274
Contract with Customer, Liability, Revenue Recognized	71,400	62,300	64,500
Revenue, Remaining Performance Obligation, Amount	$ 517,000
Revenue, Remaining Performance Obligation, Percentage	44.00%
Amortization of Deferred Sales Commissions	$ 10,599	9,169	8,768
Customer Contracts [Member]
Accounts Receivable, Credit Loss Expense (Reversal)	$ 400	$ 700	$ 300

Note 5 - Revenue Recognition and Sales Commissions 2 (Details Textual)	Dec. 31, 2022
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Month)	12 months

Note 5 - Revenue Recognition and Sales Commissions - Revenues Disaggregated By Revenue Source (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues	$ 266,826	$ 256,712	$ 244,826
Subscription Services [Member]
Revenues	253,960	243,617	233,910
Professional Services [Member]
Revenues	12,866	13,095	10,916
Healthstream Workforce Solutions [Member]
Revenues	213,589	205,443	197,587
Healthstream Workforce Solutions [Member] \| Subscription Services [Member]
Revenues	207,191	199,676	193,673
Healthstream Workforce Solutions [Member] \| Professional Services [Member]
Revenues	6,398	5,767	3,914
Healthstream Provider Solutions [Member]
Revenues	53,237	51,269	47,239
Healthstream Provider Solutions [Member] \| Subscription Services [Member]
Revenues	46,769	43,941	40,237
Healthstream Provider Solutions [Member] \| Professional Services [Member]
Revenues	$ 6,468	$ 7,328	$ 7,002

- 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.

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-Name Accounting Standards Codification
-Topic 924
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-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI https://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Note 6 - Property and Equipment (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Depreciation, Total	$ 4.5	$ 6.3	$ 6.9

Note 6 - Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property, plant and equipment	$ 35,763	$ 35,949
Accumulated depreciation and amortization	(20,280)	(17,999)
Property and equipment, net	15,483	17,950
Equipment [Member]
Property, plant and equipment	15,843	15,987
Leasehold Improvements [Member]
Property, plant and equipment	14,937	14,937
Furniture and Fixtures [Member]
Property, plant and equipment	$ 4,983	$ 5,025

Note 7 - Goodwill and Intangible Assets (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Indefinite-lived Intangible Assets (Excluding Goodwill), Ending Balance	$ 0.7
Amortization of Intangible Assets	$ 14.5	$ 14.9	$ 10.5
Trade Names [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	10 years
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	1 year
Minimum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	8 years
Minimum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	1 year
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	18 years
Maximum [Member] \| Customer Relationships [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	18 years
Maximum [Member] \| Other Intangible Assets [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	10 years

Note 7 - Goodwill and Intangible Assets - Changes in Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Balance	$ 182,501	$ 178,440
Effect of exchange rate changes	(843)	226
Balance	192,398	182,501
CloudCME, LLC [Member]
Goodwill, Acquired	6,819
ComplyALIGN [Member]
Goodwill, Acquired		945
Post-closing adjustment	40
Electronic Education Documentation System, LLC [Member]
Goodwill, Acquired	3,568
Balance	3,600
Rievent Technologies [Member]
Goodwill, Acquired		1,707
Post-closing adjustment	46
ANSOS [Member]
Post-closing adjustment	267	1,183
Healthstream Workforce Solutions [Member]
Balance	108,077	104,016
Effect of exchange rate changes	(843)	226
Balance	117,974	108,077
Healthstream Workforce Solutions [Member] \| CloudCME, LLC [Member]
Goodwill, Acquired	6,819
Healthstream Workforce Solutions [Member] \| ComplyALIGN [Member]
Goodwill, Acquired		945
Post-closing adjustment	40
Healthstream Workforce Solutions [Member] \| Electronic Education Documentation System, LLC [Member]
Goodwill, Acquired	3,568
Healthstream Workforce Solutions [Member] \| Rievent Technologies [Member]
Goodwill, Acquired		1,707
Post-closing adjustment	46
Healthstream Workforce Solutions [Member] \| ANSOS [Member]
Post-closing adjustment	267	1,183
Healthstream Provider Solutions [Member]
Balance	74,424	74,424
Effect of exchange rate changes	0	0
Balance	74,424	74,424
Healthstream Provider Solutions [Member] \| CloudCME, LLC [Member]
Goodwill, Acquired	0
Healthstream Provider Solutions [Member] \| ComplyALIGN [Member]
Goodwill, Acquired		0
Post-closing adjustment	0
Healthstream Provider Solutions [Member] \| Electronic Education Documentation System, LLC [Member]
Goodwill, Acquired	0
Healthstream Provider Solutions [Member] \| Rievent Technologies [Member]
Goodwill, Acquired		0
Post-closing adjustment	0
Healthstream Provider Solutions [Member] \| ANSOS [Member]
Post-closing adjustment	$ 0	$ 0

Note 7 - Goodwill and Intangible Assets - Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Gross Amount	$ 142,923	$ 151,572
Accumulated Amortization	(61,370)	(62,367)
Net	81,553	89,205
Customer Relationships [Member]
Gross Amount	109,821	114,418
Accumulated Amortization	(48,552)	(45,615)
Net	61,269	68,803
Other Intangible Assets [Member]
Gross Amount	33,102	37,154
Accumulated Amortization	(12,818)	(16,752)
Net	$ 20,284	$ 20,402

Note 7 - Goodwill and Intangible Assets - Expected Annual Amortization Expense (Details) $ in Thousands	Dec. 31, 2022 USD ($)
2023	$ 14,823
2024	13,313
2025	12,550
2026	9,496
2027	8,712
Thereafter	22,659
Total	$ 81,553

Note 8 - Business Combinations (Details Textual) - USD ($) $ in Thousands					1 Months Ended
	Dec. 31, 2022	May 18, 2022	Dec. 01, 2021	Jan. 19, 2021	Jan. 31, 2023	Dec. 31, 2021	Dec. 31, 2020
Goodwill, Ending Balance	$ 192,398					$ 182,501	$ 178,440
ProcessDATA, Limited [Member]
Payments to Acquire Businesses, Gross				$ 2,000
Business Acquisition, Transaction Costs				100
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net, Total				2,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Intangible Assets, Other than Goodwill, Total				1,000
Goodwill, Ending Balance				$ 1,000
Rievent Technologies [Member]
Payments to Acquire Businesses, Gross			$ 4,000
Business Acquisition, Transaction Costs			100
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net, Total			4,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Intangible Assets, Other than Goodwill, Total			2,400
Goodwill, Ending Balance			$ 1,800
CloudCME, LLC [Member]
Payments to Acquire Businesses, Gross		$ 4,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net, Total		9,600
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Intangible Assets, Other than Goodwill, Total		3,800
Goodwill, Ending Balance		$ 6,800
Business Acquisition, Percentage of Voting Interests Acquired		82.00%
Business Combination, Consideration Transferred, Equity Interests Issued and Issuable		$ 4,100
Business Combination, Step Acquisition, Equity Interest in Acquiree, Percentage		18.00%
Business Combination, Acquisition Related Costs		$ 100
Electronic Education Documentation System, LLC [Member]
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net, Total	6,600
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Intangible Assets, Other than Goodwill, Total	3,400
Goodwill, Ending Balance	3,600
Business Combination, Acquisition Related Costs	100
Business Combination, Consideration Transferred, Amount Held in Escrow	$ 600
Electronic Education Documentation System, LLC [Member] \| Subsequent Event [Member]
Payments to Acquire Businesses, Gross					$ 6,600
Business Combination, Consideration Transferred, Total					$ 7,000

Note 9 - Business Segments (Details Textual)		12 Months Ended
Note 9 - Business Segments (Details Textual)	Jan. 01, 2023	Dec. 31, 2022
Number of Operating Segments		2
Subsequent Event [Member]
Number of Operating Segments	1

Note 9 - Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Revenues, net	$ 266,826	$ 256,712	$ 244,826
Operating income	12,449	8,055	15,818
Segment Reconciling Items [Member]
Operating income	(29,906)	(31,596)	(30,482)
Healthstream Workforce Solutions [Member]
Revenues, net	213,589	205,443	197,587
Healthstream Workforce Solutions [Member] \| Operating Segments [Member]
Revenues, net	213,589	205,443	197,587
Operating income	35,498	31,736	41,622
Healthstream Provider Solutions [Member]
Revenues, net	53,237	51,269	47,239
Healthstream Provider Solutions [Member] \| Operating Segments [Member]
Revenues, net	53,237	51,269	47,239
Operating income	$ 6,857	$ 7,915	$ 4,678

- Definition

+ References

+ Details

Note 9 - Business Segments - Business Segment Information Based on Assets (Details) - USD ($)
$ in Thousands

12 Months Ended

Dec. 31, 2022

Dec. 31, 2021

Dec. 31, 2020

Assets

^[1]

$ 497,741

$ 486,753

Purchase and long-lived assets

25,855

23,442

$ 21,008

Depreciation and amortization

37,945

36,813

30,189

Segment Reconciling Items [Member]

Assets

^[1]

88,977

90,881

Purchase and long-lived assets

1,051

892

573

Depreciation and amortization

4,482

6,336

6,948

Healthstream Workforce Solutions [Member] | Operating Segments [Member]

Assets

^[1]

273,488

258,864

Purchase and long-lived assets

18,915

17,831

17,586

Depreciation and amortization

23,741

20,616

12,930

Healthstream Provider Solutions [Member] | Operating Segments [Member]

Assets

^[1]

135,276

137,008

Purchase and long-lived assets

5,889

4,719

2,849

Depreciation and amortization

$ 9,722

$ 9,861

$ 10,311

[1]

- Definition

Sum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
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+ Details

Note 10 - Income Taxes (Details Textual) - USD ($)	12 Months Ended
Note 10 - Income Taxes (Details Textual) - USD ($)	Dec. 31, 2022	Dec. 31, 2021
Deferred Tax Assets, Valuation Allowance	$ 1,947,000	$ 2,011,000
Unrecognized Tax Benefits, Increase Resulting from Evaluation Research & Development Credit Realizability Qualification	700,000
Unrecognized Tax Benefits, Income Tax Penalties and Interest Expense, Total	31,000	7,000
Unrecognized Tax Benefits that Would Impact Effective Tax Rate	1,000,000.0	$ 300,000
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options	97,000
Domestic Tax Authority [Member]
Operating Loss Carryforwards	5,500,000
Domestic Tax Authority [Member] \| Internal Revenue Service (IRS) [Member]
Income Tax Examination, Year under Examination		2018
State and Local Jurisdiction [Member]
Operating Loss Carryforwards	15,200,000
Foreign Tax Authority [Member]
Operating Loss Carryforwards	$ 8,400,000

Note 10 - Income Taxes - Schedule of Components of Earnings Before Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
United States	$ 15,777	$ 8,006	$ 17,719
Foreign	(192)	(240)	104
Earnings before income taxes	$ 15,585	$ 7,766	$ 17,823

Note 10 - Income Taxes - Summary of Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Current federal	$ 1,972	$ 5	$ (1,022)
Current state	923	406	387
Current foreign	(110)	(29)	71
Deferred federal	495	926	3,830
Deferred state	239	699	467
Deferred foreign	(25)	(86)	(1)
Provision for income taxes	$ 3,494	$ 1,921	$ 3,732

- Definition

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

+ References + Details

Note 10 - Income Taxes - Reconciliation of Income Taxes at the Statutory Federal Income Tax Rate to the Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Federal tax provision at the statutory rate	$ 3,274	$ 1,631	$ 3,743
State income tax provision, net of federal benefit	975	1,297	787
Tax credits	(1,227)	(717)	(745)
Change in valuation allowance	51	(272)	4
Adjustments for prior year taxes	(261)	(13)	(94)
Changes in uncertain tax positions	767	(10)	20
Other	(85)	5	17
Provision for income taxes	$ 3,494	$ 1,921	$ 3,732

- Definition

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

+ References + Details

Note 10 - Income Taxes - Reconciliation of the Beginning and Ending Liability for Gross Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Balance	$ 300	$ 962
Additions for tax positions in current year	743	0
Reductions for tax positions of prior years	(7)	(662)
Balance at end of year	$ 1,036	$ 300

Note 10 - Income Taxes - Significant Components of Deferred Tax Assets and Deferred Tax Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Deferred tax assets:
Allowance for credit losses	$ 142	$ 222
Accrued liabilities	1,111	1,827
Lease liability	6,896	7,548
Tax credits	362	518
Stock-based compensation	1,064	901
Deferred revenue	653	570
Basis difference on investments	0	300
Net operating loss carryforwards	4,069	7,210
Total deferred tax assets	14,297	19,096
Less: Valuation allowance	(1,947)	(2,011)
Deferred tax assets, net of valuation allowance	12,350	17,085
Deferred tax liabilities:
Deductible goodwill	5,691	4,906
Nondeductible intangible assets	2,878	3,422
Right of use assets	6,001	6,523
Prepaid assets	9,302	8,269
Capitalized software development	3,415	8,484
Depreciation	2,548	3,026
Basis difference on investments	128	0
Total deferred tax liabilities	29,963	34,630
Net deferred tax liabilities	$ 17,613	$ 17,545

Note 11 - Stock-based Compensation (Details Textual)	1 Months Ended	3 Months Ended	12 Months Ended
Note 11 - Stock-based Compensation (Details Textual)	Dec. 31, 2021 USD ($) shares	Dec. 31, 2021 USD ($)	Dec. 31, 2022 USD ($) $ / shares shares	Dec. 31, 2021 USD ($) shares	Dec. 31, 2020 USD ($)
Payment, Tax Withholding, Share-Based Payment Arrangement			$ 565,000	$ 1,182,000	$ 435,000
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options			97,000
Share-based Payment Arrangement, Expense			3,554,000	5,303,000	2,217,000
Share-based Payment Arrangement, Expensed and Capitalized, Amount, Total				$ 200,000
Chief Executive Officer [Member]
Stock Redeemed or Called During Period, Shares (in shares) \| shares	86,494
Stock Redeemed or Called During Period, Value	$ 2,250,000
Additional Stock Redeemed or Called During Period, Shares (in shares) \| shares				7,113
Stock Options And Restricted Stock Units [Member]
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount, Total			$ 6,900,000
Share-Based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition (Year)			2 years 9 months 18 days
Employee Service Share-based Compensation, Tax Benefit Expense from Exercise of Stock Options			$ 97,000
The 2016 Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period (Year)			5 years
Share-Based Compensation Arrangement by Share-Based Payment Award, Number of Shares Available for Grant (in shares) \| shares			1,254,309
Share Price (in dollars per share) \| $ / shares			$ 24.84
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Outstanding, Weighted Average Remaining Contractual Term (Year)			8 years
Restricted Stock, Shares Issued Net of Shares for Tax Withholdings (in shares) \| shares			28,000	20,000
The 2016 Plan [Member] \| Restricted Stock [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award, Equity Instruments Other than Options, Vested in Period, Fair Value			$ 3,100,000	$ 2,300,000
Payment, Tax Withholding, Share-Based Payment Arrangement			$ 600,000	500,000
The 2016 Plan [Member] \| Restricted Stock Units (RSUs) [Member]
Payment, Tax Withholding, Share-Based Payment Arrangement					$ 400,000
The 2016 Omnibus Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested, Number of Shares (in shares) \| shares	86,494
Number of Employees Awarded Fully Vested Shares	1,000
Share-based Payment Arrangement, Expense		$ 2,250,000
Payments Related to Tax Withholding for Share Based Compensation for Stock Awards				$ 700,000

Note 11 - Stock Based Compensation - Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Granted, Shares (in shares) \| shares	0
Granted, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Exercised, Shares (in shares) \| shares	0
Exercised, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Expired, Shares (in shares) \| shares	0
Expired, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Forfeited, Shares (in shares) \| shares	0
Forfeited, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Outstanding, Aggregate intrinsic value \| $	$ 405
Exercisable, Shares (in shares) \| shares	32
Exercisable, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Exercisable, Aggregate intrinsic value \| $	$ 142

Note 11 - Stock Based Compensation - RSUs Activities (Details) - Restricted Stock Units (RSUs) [Member] $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Outstanding, shares (in shares) \| shares	365
Outstanding, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 24.59
Granted, shares (in shares) \| shares	317
Granted, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 21.13
Vested, shares (in shares) \| shares	(123)
Vested, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 25.00
Forfeited, shares (in shares) \| shares	(27)
Forfeited, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 23.53
Outstanding, shares (in shares) \| shares	532
Outstanding, Weighted average grant date fair value (in dollars per share) \| $ / shares	$ 22.49
Outstanding, aggregate intrinsic value \| $	$ 13,213

Note 11 - Stock Based Compensation - Stock Based Compensation Expense (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
stock based compensation expense	$ 3,554	$ 5,303	$ 2,217
Cost of Sales [Member]
stock based compensation expense	155	944	41
Product Development [Member]
stock based compensation expense	608	1,164	363
Selling and Marketing Expense [Member]
stock based compensation expense	239	759	199
General and Administrative Expense [Member]
stock based compensation expense	$ 2,552	$ 2,436	$ 1,614

Note 12 - Employee Benefit Plan (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Defined Contribution Plan, Employer Discretionary Contribution Amount	$ 1.5	$ 2.0	$ 1.2

Note 13 - Debt (Details Textual) $ in Thousands	Oct. 28, 2020 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)
Long-Term Debt, Gross		$ 0	$ 0
Revolving Credit Facility [Member] \| Truist Bank [Member]
Debt Instrument, Covenant, Maximum Funded Debt Leverage Ratio	3.0
Debt Instrument, Covenant, Interest Coverage Ratio	3.0
Long-term Line of Credit, Total		$ 0
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Minimum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	20.00%
Revolving Credit Facility [Member] \| Truist Bank [Member] \| Maximum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	30.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 65,000
Line of Credit Facility, Increased Facility Size Due to Accordion Feature	25,000
Line of Credit Facility, Increase Basket for Dividend	$ 65,000
Leverage Ratio	1.50
Minimum Liquidity Amount	$ 30,000
Minority Owned Investment	$ 20,000
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument, Basis Spread on Variable Rate	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Fed Funds Effective Rate Overnight Index Swap Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	1.00%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member] \| Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Base Rate [Member] \| Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Eurodollar [Member] \| Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.50%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Eurodollar [Member] \| Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.75%
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Swing Line Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000
Third Amendment [Member] \| Revolving Credit Facility [Member] \| Truist Bank [Member] \| Letter of Credit Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000

Note 14 - Leases (Details Textual) - USD ($)	12 Months Ended
Note 14 - Leases (Details Textual) - USD ($)	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Operating Lease, Cost	$ 4,300,000	$ 5,500,000	$ 4,800,000
Operating Lease, Payments	$ 4,700,000	$ 5,300,000
Operating Lease, Weighted Average Remaining Lease Term (Year)	8 years 1 month 6 days
Operating Lease, Weighted Average Discount Rate, Percent	6.00%
Lessor, Operating Lease, Payment to be Received, Year One	$ 200,000
Lessor, Operating Lease, Payment to be Received, Year Two	200,000
Lessor, Operating Lease, Payment to be Received, Year Three	$ 37,000

Note 14 - Leases - Lease-related Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Operating lease right of use assets, net	$ 22,759	$ 25,168
Operating lease liability, non-current	23,321	26,178
Total operating lease liabilities	26,161	29,106
Accounts Payable and Accrued Liabilities [Member]
Operating lease liabilities, current	$ 2,840	$ 2,928

Note 14 - Leases - Maturities of Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
2023	$ 4,347
2024	4,401
2025	4,022
2026	3,650
2027	3,385
Thereafter	13,616
Total undiscounted lease payments	33,421
Less imputed interest	(7,260)
Total lease liabilities	$ 26,161	$ 29,106

Note 16 - Non-marketable Equity Investments (Details Textual) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Equity Securities without Readily Determinable Fair Value, Amount	$ 1.5	$ 2.8
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Cumulative Amount	4.1
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Annual Amount	2.8
Equity Securities without Readily Determinable Fair Value, Downward Price Adjustment, Cumulative Amount	1.3
Equity Securities without Readily Determinable Fair Value, Impairment Loss, Cumulative Amount	1.3
Nurse Grid [Member]
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Cumulative Amount		$ 0.3
Non-marketable equity investment [Member]
Equity Securities without Readily Determinable Fair Value, Upward Price Adjustment, Cumulative Amount	$ 2.7

Note 11 - Stock Based Compensation - Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($) $ / shares shares
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Granted, Shares (in shares) \| shares	0
Granted, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Exercised, Shares (in shares) \| shares	0
Exercised, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Expired, Shares (in shares) \| shares	0
Expired, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Forfeited, Shares (in shares) \| shares	0
Forfeited, Weighted average exercise price (in dollars per share) \| $ / shares	$ 0
Outstanding, Shares (in shares) \| shares	90
Outstanding, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Outstanding, Aggregate intrinsic value \| $	$ 405
Exercisable, Shares (in shares) \| shares	32
Exercisable, Weighted average exercise price (in dollars per share) \| $ / shares	$ 20.34
Exercisable, Aggregate intrinsic value \| $	$ 142