CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2015	Sep. 30, 2015	Jun. 30, 2015	Mar. 31, 2015	Dec. 31, 2014	Sep. 30, 2014	Jun. 30, 2014	Mar. 31, 2014	Dec. 31, 2015	Dec. 31, 2014	Dec. 31, 2013
Revenues:
Healthcare									$ 145,963	$ 133,178	$ 100,386
Research services									21,853	19,744	20,329
Technology									10,697	13,656	8,786
Total revenues	$ 46,774	$ 43,492	$ 44,812	$ 43,435	$ 43,653	$ 43,113	$ 42,650	$ 37,162	178,513	166,578	129,501
Cost of revenues:
Healthcare									51,693	54,942	34,179
Research									12,728	10,646	11,317
Technology									7,535	7,526	4,935
Total cost of revenues									71,956	73,114	50,431
Gross profit	28,264	26,337	26,733	25,223	24,529	23,678	23,613	21,644	106,557	93,464	79,070
Operating expenses:
General and administrative									47,882	45,131	36,569
Sales and marketing									27,936	28,805	26,275
Bad debt expense									8,047	9,347	7,787
Research and development									7,111	7,396	7,338
Other charges	1,601	1,392	1,210	1,860	2,073	1,045	1,000	2,980	6,063	7,098	7,982
Total operating expenses									97,039	97,777	85,951
Income (loss) from operations	3,458	3,006	2,585	469	(702)	486	(401)	(3,696)	9,518	(4,313)	(6,881)
Interest and other loss, net									(1,622)	(7,793)	(223)
Income (loss) before income taxes									7,896	(12,106)	(7,104)
(Provision for) benefit from income taxes									(468)	2,313	(215)
Net income (loss)	$ 2,848	$ 2,478	$ 2,171	$ (69)	$ (1,654)	$ (29)	$ (3,988)	$ (4,122)	7,428	(9,793)	(7,319)
Other comprehensive loss:
Foreign currency translation loss									(12)
Comprehensive income (loss)									$ 7,416	$ (9,793)	$ (7,319)
Net income (loss) per common share:
Basic (in dollars per share)	$ 0.10	$ 0.09	$ 0.08	$ 0.00	$ (0.06)	$ 0.00	$ (0.15)	$ (0.16)	$ 0.27	$ (0.37)	$ (0.29)
Diluted (in dollars per share)	$ 0.10	$ 0.08	$ 0.08	$ 0.00	$ (0.06)	$ 0.00	$ (0.15)	$ (0.16)	$ 0.26	$ (0.37)	$ (0.29)
Weighted average number of common shares outstanding:
Basic (in shares)									27,116,300	26,444,626	25,543,646
Diluted (in shares)									29,089,211	26,444,626	25,543,646