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Organization and Summary of Significant Accounting Policies - Narative (Details) - USD ($) | 12 Months Ended |  |
--- | --- | --- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Jan. 01, 2019 | Oct. 01, 2018
Accounting Policies [Line Items] |  |  |  |  |
Percent fair value exceeds carrying value |  |  |  |  | 41.00%
Gross profit | $ 35,616,000 | $ 4,512,000 | $ 12,976,000 |  |
Net income | 37,729,000 | 30,518,000 | 9,756,000 |  |
Revenues | 787,309,000 | 712,714,000 | 695,908,000 |  |
Selling, general, and administrative | (263,095,000) | (241,470,000) | (237,881,000) |  |
Contract with Customer, Liability | 92,417,000 | 89,397,000 |  |  |
Deferred revenues, net | 81,835,000 | 78,774,000 |  |  |
Fees to GPOs | 8,700,000 | 7,400,000 | 8,400,000 |  |
Deferred Revenues Recognized | 85,700,000 |  |  |  |
Deferred Revenue Current, Gross |  | 95,700,000 |  |  |
Capitalized Commissions | 21,100,000 | 17,900,000 | 18,800,000 |  |
Impairment Loss | 0 |  |  |  |
Purchase Obligation | 52,200,000 |  |  |  |
Sales-type Lease, Revenue | 39,200,000 | 29,600,000 | 34,900,000 |  |
Transferred non-recourse accounts receivables | 46,600,000 | 40,000,000 | 28,700,000 |  |
Accounts receivables from third-party leasing companies for transferred non-recourse accounts receivables | 10,600,000 | 100,000 | 200,000 |  |
Depreciation and amortization | 15,100,000 | 16,200,000 | 15,000,000 |  |
Total cost of revenues | $ 414,979,000 | 394,077,000 | 378,823,000 |  |
Internal use software and development costs |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Useful life (in years) | 5 years |  |  |  |
Software and development costs to be sold |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Cost of revenues for amortization of capitalized software development cost | $ 12,500,000 | 9,700,000 | 7,100,000 |  |
Min |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Estimated useful lives of assets (in years) | 1 year |  |  |  |
Max |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Estimated useful lives of assets (in years) | 30 years |  |  |  |
Max | Internal use software and development costs |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Useful life (in years) | 5 years |  |  |  |
Max | Min |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Useful life (in years) | 3 years |  |  |  |
Capitalized software costs included in property and equipment | Internal use software and development costs |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Software development costs capitalized | $ 1,100,000 | 400,000 |  |  |
Capitalized software costs included in other assets | Software and development costs to be sold |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Software development costs capitalized | 30,700,000 | 15,000,000 |  |  |
Primary Supplier |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Purchase Obligation | $ 0 |  |  |  |
Notice of termination, time upon delivery (in months) | 2 months |  |  |  |
Payments to suppliers | $ 54,800,000 | 64,500,000 | 47,900,000 |  |
International Subsidiaries Business Acquisitions |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Selling, general, and administrative | $ 2,600,000 |  |  |  |
Revolving Credit Facility |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Debt instrument, term (in years) | 5 years |  |  |  |
Term Loan Facility |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Debt instrument, term (in years) | 5 years |  |  |  |
Product revenues |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Total cost of revenues | $ 312,360,000 | 304,842,000 | 302,437,000 |  |
Product revenues | Difference between Revenue Guidance in Effect before and after Topic 606 |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Revenues |  | 800,000 |  |  |
Shipping and handling | Selling, general and administrative |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Total cost of revenues | 14,100,000 | 13,600,000 | $ 12,100,000 |  |
Foreign Exchange Forward |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Derivative, Notional Amount | $ 0 | $ 0 |  |  |
U.S. Government Hospitals | Customer Concentration Risk | Lease Receivable |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Concentration risk percentage | 49.00% |  |  |  |
Group Purchasing Organizations | Professional Services [Member] | Customer Concentration Risk |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Concentration risk percentage | 58.80% |  |  |  |
Adjustment |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Gross profit | $ 3,200,000 |  |  |  |
Net income | $ 2,500,000 |  |  |  |
Subsequent event | ASU 842 - Leases |  |  |  |  |
Accounting Policies [Line Items] |  |  |  |  |
Operating lease, right-of-use asset |  |  |  | $ 66,000,000 |
Operating lease, liability |  |  |  | $ 70,000,000 |

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