Segment Information (Details) $ in Thousands	3 Months Ended						9 Months Ended		12 Months Ended
	Sep. 30, 2020 USD ($)	Jun. 30, 2020 USD ($)	Mar. 31, 2020 USD ($)	Sep. 30, 2019 USD ($)	Jun. 30, 2019 USD ($)	Mar. 31, 2019 USD ($)	Sep. 30, 2020 USD ($) segment	Sep. 30, 2019 USD ($)	Dec. 31, 2019 USD ($)
Segment Reporting [Abstract]
Number of operating segments | segment							2
Segment Reporting Information [Line Items]
Total revenue	$ 125,444			$ 104,672			$ 318,451	$ 301,962
Total cost of revenue	71,379			53,840			190,011	155,049
Total gross profit	54,065			50,832			128,440	146,913
General and administrative	36,128			33,054			107,085	94,773
Research and development	1,964			2,611			6,129	6,407
Sales and marketing	11,304			11,508			34,757	35,048
Total operating expenses	49,396			47,173			147,971	136,228
Income (loss) from operations	4,669			3,659			(19,531)	10,685
Interest expense, net	2,458			203			4,825	3,333
Other (income) expense, net	(11)			(35)			(7,639)	5,124
Loss on extinguishment of debt	0			0			1,400	1,018	$ 1,400
Loss on termination of cash flow hedge	0			0			3,506	0
Income (loss) before taxes	2,222			3,491			(21,623)	1,210
Income tax (benefit) expense	(335)			1,348			(10,378)	(500)
Net income (loss)	2,557	$ (6,824)	$ (6,978)	2,143	$ 1,991	$ (2,424)	(11,245)	1,710
Clinical Services
Segment Reporting Information [Line Items]
Total revenue	108,733			92,565			275,599	267,757
Total cost of revenue	60,607			47,526			158,287	136,557
Total gross profit	48,126			45,039			117,312	131,200
Pharma Services
Segment Reporting Information [Line Items]
Total revenue	16,711			12,107			42,852	34,205
Total cost of revenue	10,772			6,314			31,724	18,492
Total gross profit	$ 5,939			$ 5,793			$ 11,128	$ 15,713