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Business Combinations - Additional Information (Detail)
$ in Thousands
 1 Months Ended
Sep. 15, 2016
USD ($)
Mar. 31, 2016
USD ($)
Dec. 04, 2015
USD ($)
Patient
Site
Mar. 25, 2015
USD ($)
Feb. 27, 2015
USD ($)
May 07, 2014
USD ($)
Apr. 30, 2016
USD ($)
PMG              
Business Acquisition [Line Items]              
Net cash outflow     $ 63,500        
Other liabilities assumed     $ 9,860        
Number of clinical research sites acquired | Site     48        
Working capital targets achievement period     90 days        
Working capital adjustment   $ 1,600 $ 1,613        
Working capital adjustment, cash paid             $ 1,613
Cash consideration     $ 53,681        
PMG | Minimum              
Business Acquisition [Line Items]              
Number of active patients via electronic medical records acquired | Patient     2,000,000        
MediMedia Pharma Solutions              
Business Acquisition [Line Items]              
Net cash outflow         $ 116,002    
Other liabilities assumed [1]         11,283    
Working capital adjustment         3,998    
Cash consideration, net of working capital adjustment         104,700    
Cash consideration         $ 108,717    
Aptiv Solutions              
Business Acquisition [Line Items]              
Working capital adjustment       $ 2,000   $ 1,964  
Percentage of common stock acquired           100.00%  
Cash consideration           $ 143,500  
Adjustments to cash consideration [2]           $ 22,399  
Clinical Research Management Inc.              
Business Acquisition [Line Items]              
Net cash outflow $ 52,400            
Other liabilities assumed 9,200            
Maximum additional consideration that might be payable 12,000            
Cash consideration $ 52,396            
[1] Payments made at acquisition date of $11.3 million were in respect of certain one-time liabilities which have subsequently been discharged.
[2] Adjustments to cash consideration represent certain one-time liabilities (including loan notes) identified at the acquisition date which have subsequently been paid.