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Business combinations - Schedule of MedPass Group Acquisition (Details) - USD ($)
 9 Months Ended
Jan. 22, 2020
Sep. 30, 2021
Sep. 30, 2020
Jan. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Business Acquisition [Line Items]            
Goodwill   $ 8,935,212,000     $ 936,257,000 $ 883,170,000
Cash outflows   $ 5,914,475,000 $ 37,761,000      
Medpass            
Business Acquisition [Line Items]            
Cash & cash equivalents $ 10,170,000          
Property, plant and equipment 45,000          
Operating right of use assets 539,000          
Goodwill 27,191,000          
Accounts receivable 3,033,000          
Prepayments and other current assets 158,000          
Accounts payable (368,000)          
Unearned revenue (989,000)          
Other liabilities (2,202,000)          
Current lease liabilities (219,000)          
Non-current lease liabilities (320,000)          
Non-current deferred tax liability (4,090,000)          
Net assets acquired 47,556,000          
Cash outflows 46,992,000          
Working capital adjustment paid (564,000)          
Contingent consideration 0     $ 0    
Total consideration 47,556,000          
Goodwill expected to be tax deductible 0          
Contingent consideration, maximum amount 6,700,000          
Customer relationships | Medpass            
Business Acquisition [Line Items]            
Customer relationships/ Order backlog 11,725,000          
Order backlog | Medpass            
Business Acquisition [Line Items]            
Customer relationships/ Order backlog $ 2,883,000