Business Combinations, Goodwill and Intangible Assets - Narrative (Details) - USD ($)				2 Months Ended	3 Months Ended	6 Months Ended	12 Months Ended
	Jul. 01, 2018	Dec. 22, 2017	Jun. 19, 2015	Feb. 28, 2019	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017		Dec. 31, 2016
Business Acquisition [Line Items]
Restricted common stock issued for business acquisition							$ 4,080,000	$ 0	[1]	$ 0	[1]
Acquisition related costs							1,315,000	826,000
Vesting period			4 years
Goodwill impairment							14,229,000
Goodwill					$ 349,984,000	$ 349,984,000	349,984,000	204,481,000		186,770,000
Impairment recorded					(5,827,000)	(5,827,000)	(5,827,000)	0
Intangible assets, net					94,595,000	94,595,000	94,595,000	48,058,000
Trade names and trademarks
Business Acquisition [Line Items]
Impairment recorded					(278,000)	(278,000)	(278,000)	0
Impairment charges					278,000
Intangible assets, net					4,035,000	4,035,000	4,035,000	1,917,000
Developed technology
Business Acquisition [Line Items]
Impairment recorded					0	0	0	0
Intangible assets, net					22,501,000	22,501,000	22,501,000	7,086,000
Customer relationships
Business Acquisition [Line Items]
Impairment recorded					(5,549,000)	(5,549,000)	(5,549,000)	0
Impairment charges					5,549,000
Intangible assets, net					67,874,000	67,874,000	67,874,000	38,498,000
SCIO
Business Acquisition [Line Items]
Total purchase consideration	$ 245,044,000
Revenue of acquiree since acquisition date						40,038,000
Goodwill	$ 163,751,000
SCIO | Trade names and trademarks
Business Acquisition [Line Items]
Weighted average useful life	3 years
SCIO | Developed technology
Business Acquisition [Line Items]
Weighted average useful life	5 years
SCIO | Customer relationships
Business Acquisition [Line Items]
Weighted average useful life	10 years
Health Integrated, Inc.
Business Acquisition [Line Items]
Total purchase consideration		$ 22,811,000
Initial purchase consideration		22,811,000
Maximum contingent consideration		5,000,000
Contingent cash consideration					0	0	0	920,000
Goodwill		$ 14,229,000			0	0	0
Intangible assets, net								0
Health Integrated, Inc. | Trade names and trademarks
Business Acquisition [Line Items]
Weighted average useful life		2 years
Health Integrated, Inc. | Developed technology
Business Acquisition [Line Items]
Weighted average useful life		1 year
Health Integrated, Inc. | Customer relationships
Business Acquisition [Line Items]
Weighted average useful life		7 years
Restricted Stock | SCIO
Business Acquisition [Line Items]
Stock issued during period (in shares)	69,459
Restricted common stock issued for business acquisition	$ 4,080,000
Restricted Stock Units | Health Integrated, Inc. | Subsequent Event
Business Acquisition [Line Items]
Issued number of shares of restricted stock (in shares)				4,444
Issued shares of restricted stock, fair value				$ 275,000
Vesting period				4 years
Minimum | SCIO
Business Acquisition [Line Items]
Initial purchase consideration	236,500,000
Revolving Credit Facility | SCIO
Business Acquisition [Line Items]
Utilized revolver credit facility to finance acquisition	$ 233,000,000
Healthcare
Business Acquisition [Line Items]
Goodwill impairment							14,229,000
Goodwill					$ 19,276,000	$ 19,276,000	$ 19,276,000	$ 35,233,000		$ 19,276,000

[1] Adjusted pursuant to adoption of ASU 2016-18, Statements of Cash Flows, Restricted Cash. Refer to Note 8 and Note 27 to the consolidated financial statements.