Goodwill - Changes in Carrying Amounts (Details) - USD ($) $ in Thousands	12 Months Ended
Dec. 31, 2019	Dec. 31, 2018
Changes in the carrying amounts of goodwill by segment
Balance at the beginning of the year	$ 238,814	$ 223,105
Initial goodwill acquired	62,516	475
Currency translation	(9)
Measurement period adjustments		15,234
Balance at the end of the year	301,321	238,814
Healthcare
Changes in the carrying amounts of goodwill by segment
Balance at the beginning of the year	213,507	198,273
Initial goodwill acquired	62,516	0
Currency translation	(9)
Measurement period adjustments		15,234
Balance at the end of the year	276,014	213,507
Research
Changes in the carrying amounts of goodwill by segment
Balance at the beginning of the year	16,293	16,293
Initial goodwill acquired	0	0
Currency translation	0
Measurement period adjustments		0
Balance at the end of the year	16,293	16,293
Corporate and Other
Changes in the carrying amounts of goodwill by segment
Balance at the beginning of the year	9,014	8,539
Initial goodwill acquired	0	475
Currency translation	0
Measurement period adjustments		0
Balance at the end of the year	$ 9,014	$ 9,014

Amount after accumulated impairment loss of an asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of increase in asset representing future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized resulting from a business combination.

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Amount of foreign currency translation gain (loss) which increases (decreases) an asset representing future economic benefits from other assets acquired in a business combination that are not individually identified and separately recognized.

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Amount of increase (decrease) from adjustments after acquisition date under purchase accounting of an asset representing the future economic benefits arising from other assets acquired in a business combination that are not individually identified and separately recognized.

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A roll forward is a reconciliation of a concept from the beginning of a period to the end of a period.

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