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Business combinations - Schedule of Acquisitions, MedPass Group Acquisition (Details) - USD ($)
 12 Months Ended
Jan. 22, 2020
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Jan. 31, 2021
Business Acquisition [Line Items]          
Goodwill   $ 9,037,931,000 $ 936,257,000 $ 883,170,000  
Fair value of cash consideration   $ 5,914,475,000 $ 47,931,000 $ 131,272,000  
Medpass Group Limited          
Business Acquisition [Line Items]          
Cash and 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 portion of operating lease liabilities (320,000)        
Deferred tax liabilities (4,090,000)        
Net assets acquired 47,556,000        
Fair value of cash consideration 46,992,000        
Working capital adjustment paid (564,000)        
Contingent consideration 0       $ 0
Total consideration 47,556,000        
Goodwill, expected tax deductible amount 0        
Contingent consideration, range of outcomes, maximum value 6,700,000        
Medpass Group Limited | Customer relationships          
Business Acquisition [Line Items]          
Intangible assets 11,725,000        
Medpass Group Limited | Order backlog          
Business Acquisition [Line Items]          
Intangible assets $ 2,883,000