Summary of Significant Accounting Policies - Narrative (Detail) (USD $)	12 Months Ended
	Dec. 31, 2013 Claim	Dec. 31, 2012 Claim	Dec. 31, 2011
Significant Accounting Policies [Line Items]
Outstanding standby letters of credit as collateral	$ 6,399,000	$ 6,899,000
Outstanding workers' compensation benefit claims	85	105
Outstanding professional liability claims	66	80
Accrued revenue	11,004,000	9,816,000
Deferred tax benefits related to share based compensation		955,000	1,126,000
Advertising costs	3,230,000	3,186,000	3,180,000
Prepaid expenses, advertising	1,338,000	958,000
Restructuring costs	483,578	0	0
Cumulative impact of currency fluctuations	1,133,000	3,083,000
Reclassification of currency translation adjustments related to sale of clinical trial services business	2,336,201	0	0
Income tax (benefit) expense related to items of other comprehensive (loss) income	(162,484)	14,951	(22,384)
Employee Severance [Member]
Significant Accounting Policies [Line Items]
Restructuring costs	484,000
Selling, General and Administrative Expenses [Member]
Significant Accounting Policies [Line Items]
Equity compensation	2,099,941	2,594,523	2,895,012
Occurrence-Based Professional Liability Insurance [Member] | MDA Holdings Inc [Member]
Significant Accounting Policies [Line Items]
Letter of credit for malpractice claims	5,000,000	5,533,000
Other Current Liabilities [Member]
Significant Accounting Policies [Line Items]
Deferred revenue	$ 1,293,000	$ 1,574,000
Minimum [Member]
Significant Accounting Policies [Line Items]
Contract terms	15 days
Short term leases period	3 months
Estimated useful life of assets	3 years
Intangible assets- useful life	5 years
Minimum [Member] | Computer software [Member]
Significant Accounting Policies [Line Items]
Estimated useful life of assets	3 years
Maximum [Member]
Significant Accounting Policies [Line Items]
Contract terms	60 days
Short term leases period	6 months
Estimated useful life of assets	7 years
Intangible assets- useful life	16 years
Maximum [Member] | Computer software [Member]
Significant Accounting Policies [Line Items]
Estimated useful life of assets	5 years