HealthStream (HSTM) 10-Q 28 Oct 21 2021 Q3 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	9 Months Ended
	Sep. 30, 2021	Oct. 25, 2021
Document Information [Line Items]
Entity Central Index Key	0001095565
Entity Registrant Name	HEALTHSTREAM INC
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2021
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
Document Transition Report	false
Entity File Number	000-27701
Entity Incorporation, State or Country Code	TN
Entity Tax Identification Number	62-1443555
Entity Address, Address Line One	500 11th Avenue North, Suite 1000
Entity Address, City or Town	Nashville
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37203
City Area Code	615
Local Phone Number	301-3100
Title of 12(b) Security	Common Stock (Par Value $0.00)
Trading Symbol	HSTM
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		31,562,193

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands		Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents		$ 55,459	$ 36,566
Marketable securities		5,095	9,928
Accounts receivable, net of allowance for doubtful accounts of $408 and $549 at September 30, 2021 and December 31, 2020, respectively		26,991	40,726
Accounts receivable - unbilled		3,754	5,374
Prepaid royalties, net of amortization		9,733	9,571
Other prepaid expenses and other current assets		11,224	12,560
Total current assets		112,256	114,725
Property and equipment, net of accumulated depreciation of $24,131 and $19,237 at September 30, 2021 and December 31, 2020, respectively		18,333	22,218
Capitalized software development, net of accumulated amortization of $81,734 and $70,516 at September 30, 2021 and December 31, 2020, respectively		31,250	26,631
Operating lease right of use assets, net		25,869	28,081
Goodwill		181,114	178,440
Deferred tax assets		974	974
Deferred commissions		22,860	19,907
Non-marketable equity investments		8,338	6,845
Other assets		3,375	1,777
Total assets	[1]	494,714	500,313
Current liabilities:
Accounts payable and accrued expenses		22,170	29,457
Accrued royalties		5,203	8,809
Deferred revenue		74,577	81,176
Total current liabilities		101,950	119,442
Deferred tax liabilities		18,205	14,523
Deferred revenue, noncurrent		1,915	1,603
Operating lease liability, noncurrent		26,852	28,479
Other long term liabilities		3,594	2,204
Commitments and contingencies
Shareholders’ equity:
Common stock, no par value, 75,000 shares authorized; 31,562 and 31,493 shares issued and outstanding at September 30, 2021 and December 31, 2020, respectively		273,573	271,784
Retained earnings		68,510	62,277
Accumulated other comprehensive income		115	1
Total shareholders’ equity		342,198	334,062
Total liabilities and shareholders’ equity		494,714	500,313
Customer-Related Intangible Assets [Member]
Current assets:
Intangible assets, net of accumulated amortization		70,782	76,927
Other Intangible Assets [Member]
Current assets:
Intangible assets, net of accumulated amortization		$ 19,563	$ 23,788
[1]	Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, goodwill, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not allocated to individual segments and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - USD ($) shares in Thousands, $ / shares in Thousands, $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Accounts receivable, allowance for doubtful accounts	$ 408	$ 549
Accumulated amortization on property and equipment	24,131	19,237
Accumulated amortization on capitalized software development	$ 81,734	$ 70,516
Common stock, shares authorized (in shares)	75,000	75,000
Common stock, shares issued (in shares)	31,562	31,493
Common stock, shares outstanding (in shares)	31,562	31,493
Common stock, par value (in dollars per share)	$ 0	$ 0
Customer-Related Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 43,362	$ 36,723
Other Intangible Assets [Member]
Accumulated amortization on intangible assets	$ 15,431	$ 10,748

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues, net	$ 64,091	$ 60,883	$ 192,374	$ 183,008
Operating costs and expenses:
Cost of revenues (excluding depreciation and amortization)	22,585	23,302	68,053	66,596
Product development	10,344	8,192	30,205	23,491
Sales and marketing	10,232	8,863	28,713	26,286
Other general and administrative expenses	10,004	9,986	29,445	29,949
Depreciation and amortization	9,141	7,406	27,443	22,005
Total operating costs and expenses	62,306	57,749	183,859	168,327
Operating income	1,785	3,134	8,515	14,681
Other (loss) income, net	(99)	100	(250)	2,006
Income before income tax provision	1,686	3,234	8,265	16,687
Income tax provision	186	600	2,033	3,519
Net income	$ 1,500	$ 2,634	$ 6,232	$ 13,168
Net income per share:
Basic (in dollars per share)	$ 0.05	$ 0.08	$ 0.20	$ 0.41
Diluted (in dollars per share)	$ 0.05	$ 0.08	$ 0.20	$ 0.41
Weighted average shares of common stock outstanding:
Basic (in shares)	31,558	31,955	31,538	32,095
Diluted (in shares)	31,684	31,981	31,609	32,121

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Net income	$ 1,500	$ 2,634	$ 6,232	$ 13,168
Other comprehensive income, net of taxes:
Foreign currency translation adjustments	(470)	23	107	(4)
Unrealized (loss) gain on marketable securities	(1)	(18)	7	6
Total other comprehensive (loss) income	(471)	5	114	2
Comprehensive income	$ 1,029	$ 2,639	$ 6,346	$ 13,170

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Shareholders' Equity (Unaudited) - USD ($) shares in Thousands, $ in Thousands	Common Stock Including Additional Paid in Capital [Member]	Retained Earnings [Member]	AOCI Attributable to Parent [Member]	Total
Balance (in shares) at Dec. 31, 2019	32,379
Balance at Dec. 31, 2019	$ 290,021	$ 48,143	$ 4	$ 338,168
Net income	0	7,092	0	7,092
Comprehensive income (loss)	0	0	(145)	(145)
Stock based compensation	$ 550	0	0	550
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	62
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (373)	0	0	(373)
Repurchase of common stock (in shares)	(438)
Repurchase of common stock	$ (9,876)	0	0	(9,876)
Balance (in shares) at Mar. 31, 2020	32,003
Balance at Mar. 31, 2020	$ 280,322	55,235	(141)	335,416
Balance (in shares) at Dec. 31, 2019	32,379
Balance at Dec. 31, 2019	$ 290,021	48,143	4	338,168
Net income				13,168
Comprehensive income (loss)				2
Balance (in shares) at Sep. 30, 2020	31,686
Balance at Sep. 30, 2020	$ 274,905	61,354	6	336,265
Balance (in shares) at Mar. 31, 2020	32,003
Balance at Mar. 31, 2020	$ 280,322	55,235	(141)	335,416
Net income	0	3,442	0	3,442
Comprehensive income (loss)	0	0	142	142
Stock based compensation	$ 557	0	0	557
Repurchase of common stock (in shares)	(6)
Repurchase of common stock	$ (133)	0	0	(133)
Balance (in shares) at Jun. 30, 2020	31,997
Balance at Jun. 30, 2020	$ 280,746	58,677	1	339,424
Net income	0	2,634	0	2,634
Comprehensive income (loss)	0	0	5	5
Stock based compensation	$ 557	0	0	557
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	8
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (55)	0	0	(55)
Repurchase of common stock (in shares)	(319)
Repurchase of common stock	$ (6,343)	0	0	(6,343)
Dividend forfeitures	$ 0	43	0	43
Balance (in shares) at Sep. 30, 2020	31,686
Balance at Sep. 30, 2020	$ 274,905	61,354	6	336,265
Balance (in shares) at Dec. 31, 2020	31,493
Balance at Dec. 31, 2020	$ 271,784	62,277	1	334,062
Net income	0	2,291	0	2,291
Comprehensive income (loss)	0	0	234	234
Stock based compensation	$ 616	0	0	616
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	60
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (399)	0	0	(399)
Balance (in shares) at Mar. 31, 2021	31,553
Balance at Mar. 31, 2021	$ 272,001	64,569	235	336,805
Balance (in shares) at Dec. 31, 2020	31,493
Balance at Dec. 31, 2020	$ 271,784	62,277	1	334,062
Net income				6,232
Comprehensive income (loss)				114
Balance (in shares) at Sep. 30, 2021	31,562
Balance at Sep. 30, 2021	$ 273,573	68,510	115	342,198
Balance (in shares) at Mar. 31, 2021	31,553
Balance at Mar. 31, 2021	$ 272,001	64,569	235	336,805
Net income	0	2,441	0	2,441
Comprehensive income (loss)	0	0	351	351
Stock based compensation	$ 782	0	0	782
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	1
Common stock issued under stock plans, net of shares withheld for employee taxes	$ 0	0	0	0
Balance (in shares) at Jun. 30, 2021	31,554
Balance at Jun. 30, 2021	$ 272,783	67,010	586	340,379
Net income	0	1,500	0	1,500
Comprehensive income (loss)	0	0	(471)	(471)
Stock based compensation	$ 862	0	0	862
Common stock issued under stock plans, net of shares withheld for employee taxes (in shares)	8
Common stock issued under stock plans, net of shares withheld for employee taxes	$ (72)	0	0	(72)
Balance (in shares) at Sep. 30, 2021	31,562
Balance at Sep. 30, 2021	$ 273,573	$ 68,510	$ 115	$ 342,198

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
OPERATING ACTIVITIES:
Net income	$ 6,232	$ 13,168
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	27,443	22,005
Stock based compensation	2,260	1,665
Amortization of deferred commissions	6,900	6,555
Provision for doubtful accounts	99	160
Deferred income taxes	2,066	2,330
Loss on non-marketable equity investments	258	8
Non-cash paid time off expense	(1,011)	0
Non-cash royalty expense	0	(3,440)
Change in fair value of non-marketable equity investments	0	(1,181)
Other	132	321
Changes in operating assets and liabilities:
Accounts and unbilled receivables	(13,907)	9
Prepaid royalties	(162)	1,394
Other prepaid expenses and other current assets	1,335	972
Deferred commissions	(9,854)	(6,693)
Other assets	(278)	308
Accounts payable and accrued expenses	(3,062)	(450)
Accrued royalties	(3,606)	(3,218)
Deferred revenue	(6,223)	(3,142)
Net cash provided by operating activities	36,436	30,753
INVESTING ACTIVITIES:
Business combinations, net of cash acquired	(731)	(21,449)
Proceeds from maturities of marketable securities	9,931	59,522
Purchases of marketable securities	(5,223)	(61,178)
Payments to acquire non-marketable equity investments	0	(1,257)
Payments to acquire equity method investments	(1,750)	0
Payments associated with capitalized software development	(16,577)	(12,366)
Purchases of property and equipment	(2,602)	(1,734)
Net cash used in investing activities	(16,952)	(38,462)
FINANCING ACTIVITIES:
Taxes paid related to net settlement of equity awards	(471)	(429)
Repurchases of common stock	0	(16,352)
Payment of cash dividends	(19)	(40)
Net cash used in financing activities	(490)	(16,821)
Effect of exchange rate changes on cash and cash equivalents	(101)	(1)
Net increase (decrease) in cash and cash equivalents	18,893	(24,531)
Cash and cash equivalents at beginning of period	36,566	131,538
Cash and cash equivalents at end of period	55,459	107,007
SUPPLEMENTAL CASH FLOW INFORMATION:
Non-cash additions to non-marketable equity investments	$ 0	$ 1,300

Note 1 - Basis of Presentation

Note 1 - Basis of Presentation	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Business Description and Basis of Presentation [Text Block]	1. BASIS OF PRESENTATION The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the United States (“US GAAP”) for interim financial information and with the instructions to Form 10‑Q 10 not three nine September 30, 2021 not may December 31, 2021. The Condensed Consolidated Balance Sheet at December 31, 2020 not December 31, 2020 10 February 25, 2021).

Note 2 - Revenue Recognition an

Note 2 - Revenue Recognition and Sales Commissions	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	2. Revenue Recognition Revenues are recognized when control of the promised goods or services is transferred to the customer in an amount that reflects the consideration the Company expects to be entitled in exchange for transferring those goods or services. Revenue is recognized based on the following five • Identification of the contract with a customer • Identification of the performance obligations in the contract • Determination of the transaction price • Allocation of the transaction price to the performance obligations in the contract • Recognition of revenue when, or as, the Company satisfies a performance obligation The following table represents revenues disaggregated by revenue source (in thousands). Sales taxes are excluded from revenues. Three Months Ended September 30, 2021 Nine Months Ended September 30, 2021 Business Segments Workforce Solutions Provider Solutions Consolidated Workforce Solutions Provider Solutions Consolidated Subscription services $ 49,729 $ 10,973 $ 60,702 $ 150,239 $ 32,475 $ 182,714 Professional services 1,426 1,963 3,389 4,320 5,340 9,660 Total revenues, net $ 51,155 $ 12,936 $ 64,091 $ 154,559 $ 37,815 $ 192,374 Three Months Ended September 30, 2020 Nine Months Ended September 30, 2020 Business Segments Workforce Solutions Provider Solutions Consolidated Workforce Solutions Provider Solutions Consolidated Subscription services $ 48,246 $ 9,999 $ 58,245 $ 144,945 $ 29,937 $ 174,882 Professional services 951 1,687 2,638 2,964 5,162 8,126 Total revenues, net $ 49,197 $ 11,686 $ 60,883 $ 147,909 $ 35,099 $ 183,008 For the nine September 30, 2021 2020 Deferred revenue represents contract liabilities that are recorded when cash payments are received or are due in advance of our satisfaction of performance obligations. During the three September 30, 2021 2020 nine September 30, 2021 2020 September 30, 2021 Sales Commissions Sales commissions earned by our sales force are considered incremental and recoverable costs of obtaining a contract with a customer. Under ASC 606, not three three September 30, 2021 2020 nine September 30, 2021 2020

Note 3 - Income Taxes

Note 3 - Income Taxes	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Income Tax Disclosure [Text Block]	3. Income taxes are accounted for using the asset and liability method, whereby deferred tax assets and liabilities are determined based on the temporary differences between the financial statement and tax bases of assets and liabilities measured at tax rates that will be in effect for the year in which the differences are expected to affect taxable income. The Company computes its interim period provision for income taxes by applying the estimated annual effective tax rate to year-to-date pretax income or loss and adjusts the provision for discrete tax items recorded in the period. During the three September 30, 2021 2020 nine September 30, 2021 2020 nine September 30, 2021 2020 nine September 30, 2021 nine September 30, 2020 not

Note 4 - Shareholders' Equity

Note 4 - Shareholders' Equity	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Stockholders' Equity Note Disclosure [Text Block]	4. SHAREHOLDERS EQUITY Stock Based Compensation The Company has stock awards outstanding under its 2016 nine September 30, 2021 nine September 30, 2020 Total stock based compensation expense recognized in the Condensed Consolidated Statements of Income is as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of revenues (excluding depreciation and amortization) $ 31 $ 16 $ 82 $ 39 Product development 111 92 329 266 Sales and marketing 76 60 217 170 Other general and administrative 644 389 1,632 1,190 Total stock based compensation expense $ 862 $ 557 $ 2,260 $ 1,665

Note 5 - Earnings Per Share

Note 5 - Earnings Per Share	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Earnings Per Share [Text Block]	5. EARNINGS PER SHARE Basic earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of common shares outstanding during the period. Diluted earnings per share is computed by dividing the net income available to common shareholders for the period by the weighted average number of potentially dilutive common and common equivalent shares outstanding during the period. Common equivalent shares are composed of incremental common shares issuable upon the exercise of stock options and RSUs subject to vesting. The dilutive effect of common equivalent shares is included in diluted earnings per share by application of the treasury stock method. The total number of common equivalent shares excluded from the calculations of diluted earnings per share, due to their anti-dilutive effect or contingent performance conditions, was approximately 26,000 and 115,000 for the three September 30, 2021 2020 nine September 30, 2021 2020 The following table sets forth the computation of basic and diluted earnings per share (in thousands, except per share data): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Numerator: Net income $ 1,500 $ 2,634 $ 6,232 $ 13,168 Denominator: Weighted-average shares outstanding 31,558 31,955 31,538 32,095 Effect of dilutive shares 126 26 71 26 Weighted-average diluted shares 31,684 31,981 31,609 32,121 Net income per share: Basic $ 0.05 $ 0.08 $ 0.20 $ 0.41 Diluted $ 0.05 $ 0.08 $ 0.20 $ 0.41

Note 6 - Marketable Securities

Note 6 - Marketable Securities	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure [Text Block]	6. The fair value of marketable securities, which were all classified as available for sale and which the Company does not September 30, 2021 Adjusted Cost Unrealized Gains Unrealized Losses Fair Value Cash and Cash Equivalents Current Marketable Securities Cash $ 55,459 $ — $ — $ 55,459 $ 55,459 $ — Level 2: Corporate debt securities 5,096 — (1 ) 5,095 — 5,095 Total $ 60,555 $ — $ (1 ) $ 60,554 $ 55,459 $ 5,095 December 31, 2020 Adjusted Cost Unrealized Gains Unrealized Losses Fair Value Cash and Cash Equivalents Current Marketable Securities Cash $ 31,558 $ — $ — $ 31,558 $ 31,558 $ — Level 2: Time deposits 10,021 — — 10,021 5,008 5,013 Corporate debt securities 4,923 — (8 ) 4,915 — 4,915 Total $ 46,502 $ — $ (8 ) $ 46,494 $ 36,566 $ 9,928 The carrying amounts reported in the Condensed Consolidated Balance Sheets approximate the fair value based on quoted market prices or alternative pricing sources and models utilizing market observable inputs. As of September 30, 2021 not one

Note 7 - Business Combinations

Note 7 - Business Combinations	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Business Combination Disclosure [Text Block]	7. NurseGrid On March 9, 2020, HcT2 three March 31, 2020. March 9, 2020. A summary of the purchase price is as follows (in thousands): Cash paid at closing $ 25,485 Post-closing adjustment, net of cash received 33 Cash acquired (4,064 ) Net consideration paid 21,454 Fair value of existing equity interest in NurseGrid 3,623 Net consideration paid $ 25,077 The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands): Accounts and unbilled receivable, net $ 92 Prepaid and other current assets 155 Operating lease right-of-use assets 50 Deferred tax assets 2,121 Goodwill 21,085 Intangible assets 1,845 Accounts payable and accrued liabilities (143 ) Deferred revenue (78 ) Operating lease liabilities (50 ) Net assets acquired $ 25,077 The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The primary intangible assets acquired were developed technology and trade name. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. The fair value estimate for trade name intangible asset included significant assumptions in the prospective financial information, such as projected revenues, royalty rate, and the discount rate. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, future market opportunities to engage and support the NurseGrid Mobile user community, and expected synergies from integrating NurseGrid with other combined functional areas within the Company. The goodwill balance is not The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands): Fair value Useful life (in years) Customer relationships $ 35 8 Developed technology 1,110 5 Trade name 700 Indefinite Total intangible assets $ 1,845 The following unaudited pro forma financial information summarizes the results of operations of the Company and NurseGrid as though the companies were combined as of January 1, 2019 ( Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,091 $ 60,900 $ 192,379 $ 183,133 Net income $ 1,500 $ 2,648 $ 6,236 $ 12,632 Net income per share - basic $ 0.05 $ 0.08 $ 0.20 $ 0.39 Net income per share - diluted $ 0.05 $ 0.08 $ 0.20 $ 0.39 These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, interest expense related to NurseGrid’s previously outstanding debt, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not ShiftWizard On October 12, 2020, October 12, 2020. The following table summarizes the fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands): Cash $ 1,091 Accounts and unbilled receivable, net 1,038 Prepaid assets 106 Operating lease right-of-use assets 183 Property and equipment 50 Indemnification assets 464 Goodwill 19,307 Intangible asset 12,660 Accounts payable and accrued liabilities (600 ) Deferred revenue (1,601 ) Deferred tax liability (1,559 ) Operating lease liabilities (183 ) Indemnification liability (464 ) Net assets acquired $ 30,492 The excess of purchase price over the fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. Included in the assets and liabilities is an indemnification asset and liability of $0.5 million associated with a Paycheck Protection Program loan pending forgiveness as of the acquisition date that was subsequently forgiven. The primary intangible assets acquired were customer relationships and developed technology. The fair value estimate for customer relationships intangible asset included significant assumptions in the prospective financial information, such as revenue growth, customer attrition, EBITDA margin, and the discount rate. The fair value estimate for developed technology intangible asset included significant assumptions, including the estimate of employee hours that would be needed to recreate the technology. Additionally, these assumptions are forward looking and could be affected by future economic and market conditions. The goodwill balance is primarily attributed to the assembled workforce, additional market opportunities from offering ShiftWizard products, and expected synergies from integrating ShiftWizard with other products or other combined functional areas within the Company. The goodwill balance is not The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands): Fair Value Useful life (in years) Customer relationships $ 7,800 18 Developed technology 4,050 5 Non-compete 580 1 - 5 Trade name 230 5 Total intangible assets $ 12,660 The following unaudited pro forma financial information summarizes the results of operations of the Company and ShiftWizard as though the companies were combined as of January 1, 2019 ( Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,210 $ 61,930 $ 192,910 $ 186,049 Net income $ 1,615 $ 2,169 $ 6,690 $ 11,985 Net income per share - basic $ 0.05 $ 0.07 $ 0.21 $ 0.37 Net income per share - diluted $ 0.05 $ 0.07 $ 0.21 $ 0.37 These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not ANSOS ™ Staff Scheduling application On December 2, 2020, December 2, 2020. The following table summarizes the preliminary fair value of the assets acquired and liabilities assumed as of the date of acquisition (in thousands): Cash $ 1,599 Accounts and unbilled receivable, net 10,099 Prepaid assets 233 Operating lease right-of-use assets 888 Property and equipment 66 Deferred tax assets 2,855 Indemnification asset 2,029 Goodwill 36,748 Intangible assets 32,440 Accounts payable and accrued liabilities (1,776 ) Deferred revenue (14,204 ) Operating lease liabilities (888 ) Deferred tax liability (1,612 ) Uncertain tax position liability (2,029 ) Net assets acquired $ 66,448 The excess of purchase price over the preliminary fair values of net tangible and intangible assets is recorded as goodwill. The fair values of tangible and identifiable intangible assets and liabilities are based on management’s estimates and assumptions. The preliminary fair values of assets acquired and liabilities assumed continue to be subject to change during the measurement period (up to one not nine September 30, 2021 no The portion of goodwill allocated to the U.S. entity is deductible for U.S. income tax purposes (representing 95%). The net tangible assets include deferred revenue, which was adjusted down from a book value at the acquisition date of $17.5 million to an estimated fair value of $14.2 million. The $3.3 million write-down of deferred revenue will result in lower revenues than would have otherwise been recognized for such services. The following table sets forth the components of identifiable intangible assets and their estimated useful lives as of the acquisition date (in thousands): Fair Value Useful life (in years) Customer relationships $ 21,100 11 - 14 Developed technology 9,800 5 Trade name 1,540 10 Total intangible assets $ 32,440 The following unaudited pro forma financial information summarizes the results of operations of the Company and ANSOS as though the companies were combined as of January 1, 2019 ( Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,636 $ 66,924 $ 194,856 $ 203,129 Net income $ 1,965 $ 3,407 $ 8,190 $ 16,514 Net income per share - basic $ 0.06 $ 0.11 $ 0.26 $ 0.51 Net income per share - diluted $ 0.06 $ 0.11 $ 0.26 $ 0.51 These unaudited pro forma combined results of operations include certain adjustments arising from the acquisition, such as amortization of intangible assets, depreciation of property and equipment, and fair value adjustments of acquired deferred revenue balances. The unaudited pro forma combined results of operations is for informational purposes only and is not Other Business Combinations On December 10, 2020, not On January 19, 2021, not During the nine September 30, 2021

Note 8 - Business Segments

Note 8 - Business Segments	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	8. The Company provides services to healthcare organizations and other members within the healthcare industry. The Company’s services are focused on the delivery of workforce training, certification, assessment, development, and scheduling products and services (Workforce Solutions) and provider credentialing, privileging, call center, and enrollment products and services (Provider Solutions). The Company measures segment performance based on operating income before income taxes and prior to the allocation of certain corporate overhead expenses, interest income, interest expense, gains and losses from equity investments, and depreciation. The Unallocated component below includes corporate functions, such as accounting, human resources, legal, investor relations, information systems, administrative and executive personnel, depreciation, a portion of amortization, and certain other expenses, which are not Three Months Ended September 30, Nine Months Ended September 30, Revenues, net: 2021 2020 2021 2020 Workforce Solutions $ 51,155 $ 49,197 $ 154,559 $ 147,909 Provider Solutions 12,936 11,686 37,815 35,099 Total revenues, net $ 64,091 $ 60,883 $ 192,374 $ 183,008 Operating income: Workforce Solutions $ 7,732 $ 9,758 $ 25,981 $ 33,575 Provider Solutions 1,974 913 6,195 3,382 Unallocated (7,921 ) (7,537 ) (23,661 ) (22,276 ) Total operating income $ 1,785 $ 3,134 $ 8,515 $ 14,681 Segment assets * September 30, 2021 December 31, 2020 Workforce Solutions $ 259,036 $ 270,924 Provider Solutions 134,793 140,490 Unallocated 100,885 88,899 Total assets $ 494,714 $ 500,313 * Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, goodwill, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not

Note 9 - Debt

Note 9 - Debt	9 Months Ended
	Sep. 30, 2021
Notes to Financial Statements
Debt Disclosure [Text Block]	9. Revolving Credit Facility On October 28, 2020, November 24, 2014 October 28, 2023. may At the Company’s election, the borrowings under the Revolving Credit Facility bear interest at either ( 1 one 2 six October 28, 2023, no The purpose of the Revolving Credit Facility is for general working capital needs, permitted acquisitions (as defined in the Revolving Credit Facility), and for stock repurchase and/or redemption transactions that the Company may The Revolving Credit Facility contains certain covenants that, among other things, restrict additional indebtedness, liens and encumbrances, changes to the character of the Company’s business, acquisitions, asset dispositions, mergers and consolidations, sale or discount of receivables, creation or acquisitions of additional subsidiaries, and other matters customarily restricted in such agreements. In addition, the Revolving Credit Facility requires the Company to meet certain financial tests, including, without limitation: • a funded debt leverage ratio (consolidated debt/consolidated EBITDA) of not 1.0; • an interest coverage ratio (consolidated EBITDA/consolidated interest expense) of not 1.0. As of September 30, 2021 no three nine September 30, 2021

Note 2 - Revenue Recognition _2

Note 2 - Revenue Recognition and Sales Commissions (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Disaggregation of Revenue [Table Text Block]	Three Months Ended September 30, 2021 Nine Months Ended September 30, 2021 Business Segments Workforce Solutions Provider Solutions Consolidated Workforce Solutions Provider Solutions Consolidated Subscription services $ 49,729 $ 10,973 $ 60,702 $ 150,239 $ 32,475 $ 182,714 Professional services 1,426 1,963 3,389 4,320 5,340 9,660 Total revenues, net $ 51,155 $ 12,936 $ 64,091 $ 154,559 $ 37,815 $ 192,374 Three Months Ended September 30, 2020 Nine Months Ended September 30, 2020 Business Segments Workforce Solutions Provider Solutions Consolidated Workforce Solutions Provider Solutions Consolidated Subscription services $ 48,246 $ 9,999 $ 58,245 $ 144,945 $ 29,937 $ 174,882 Professional services 951 1,687 2,638 2,964 5,162 8,126 Total revenues, net $ 49,197 $ 11,686 $ 60,883 $ 147,909 $ 35,099 $ 183,008

Note 4 - Shareholders' Equity (

Note 4 - Shareholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of revenues (excluding depreciation and amortization) $ 31 $ 16 $ 82 $ 39 Product development 111 92 329 266 Sales and marketing 76 60 217 170 Other general and administrative 644 389 1,632 1,190 Total stock based compensation expense $ 862 $ 557 $ 2,260 $ 1,665

Note 5 - Earnings Per Share (Ta

Note 5 - Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Numerator: Net income $ 1,500 $ 2,634 $ 6,232 $ 13,168 Denominator: Weighted-average shares outstanding 31,558 31,955 31,538 32,095 Effect of dilutive shares 126 26 71 26 Weighted-average diluted shares 31,684 31,981 31,609 32,121 Net income per share: Basic $ 0.05 $ 0.08 $ 0.20 $ 0.41 Diluted $ 0.05 $ 0.08 $ 0.20 $ 0.41

Note 6 - Marketable Securities

Note 6 - Marketable Securities (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Debt Securities, Available-for-sale [Table Text Block]	September 30, 2021 Adjusted Cost Unrealized Gains Unrealized Losses Fair Value Cash and Cash Equivalents Current Marketable Securities Cash $ 55,459 $ — $ — $ 55,459 $ 55,459 $ — Level 2: Corporate debt securities 5,096 — (1 ) 5,095 — 5,095 Total $ 60,555 $ — $ (1 ) $ 60,554 $ 55,459 $ 5,095 December 31, 2020 Adjusted Cost Unrealized Gains Unrealized Losses Fair Value Cash and Cash Equivalents Current Marketable Securities Cash $ 31,558 $ — $ — $ 31,558 $ 31,558 $ — Level 2: Time deposits 10,021 — — 10,021 5,008 5,013 Corporate debt securities 4,923 — (8 ) 4,915 — 4,915 Total $ 46,502 $ — $ (8 ) $ 46,494 $ 36,566 $ 9,928

Note 7 - Business Combinations

Note 7 - Business Combinations (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Schedule of Business Acquisitions, by Acquisition [Table Text Block]	Cash paid at closing $ 25,485 Post-closing adjustment, net of cash received 33 Cash acquired (4,064 ) Net consideration paid 21,454 Fair value of existing equity interest in NurseGrid 3,623 Net consideration paid $ 25,077
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed [Table Text Block]	Accounts and unbilled receivable, net $ 92 Prepaid and other current assets 155 Operating lease right-of-use assets 50 Deferred tax assets 2,121 Goodwill 21,085 Intangible assets 1,845 Accounts payable and accrued liabilities (143 ) Deferred revenue (78 ) Operating lease liabilities (50 ) Net assets acquired $ 25,077 Cash $ 1,091 Accounts and unbilled receivable, net 1,038 Prepaid assets 106 Operating lease right-of-use assets 183 Property and equipment 50 Indemnification assets 464 Goodwill 19,307 Intangible asset 12,660 Accounts payable and accrued liabilities (600 ) Deferred revenue (1,601 ) Deferred tax liability (1,559 ) Operating lease liabilities (183 ) Indemnification liability (464 ) Net assets acquired $ 30,492 Cash $ 1,599 Accounts and unbilled receivable, net 10,099 Prepaid assets 233 Operating lease right-of-use assets 888 Property and equipment 66 Deferred tax assets 2,855 Indemnification asset 2,029 Goodwill 36,748 Intangible assets 32,440 Accounts payable and accrued liabilities (1,776 ) Deferred revenue (14,204 ) Operating lease liabilities (888 ) Deferred tax liability (1,612 ) Uncertain tax position liability (2,029 ) Net assets acquired $ 66,448
Schedule of Finite-Lived Intangible Assets Acquired as Part of Business Combination [Table Text Block]	Fair value Useful life (in years) Customer relationships $ 35 8 Developed technology 1,110 5 Trade name 700 Indefinite Total intangible assets $ 1,845 Fair Value Useful life (in years) Customer relationships $ 7,800 18 Developed technology 4,050 5 Non-compete 580 1 - 5 Trade name 230 5 Total intangible assets $ 12,660 Fair Value Useful life (in years) Customer relationships $ 21,100 11 - 14 Developed technology 9,800 5 Trade name 1,540 10 Total intangible assets $ 32,440
Business Acquisition, Pro Forma Information [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,091 $ 60,900 $ 192,379 $ 183,133 Net income $ 1,500 $ 2,648 $ 6,236 $ 12,632 Net income per share - basic $ 0.05 $ 0.08 $ 0.20 $ 0.39 Net income per share - diluted $ 0.05 $ 0.08 $ 0.20 $ 0.39 Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,210 $ 61,930 $ 192,910 $ 186,049 Net income $ 1,615 $ 2,169 $ 6,690 $ 11,985 Net income per share - basic $ 0.05 $ 0.07 $ 0.21 $ 0.37 Net income per share - diluted $ 0.05 $ 0.07 $ 0.21 $ 0.37 Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Total revenues $ 64,636 $ 66,924 $ 194,856 $ 203,129 Net income $ 1,965 $ 3,407 $ 8,190 $ 16,514 Net income per share - basic $ 0.06 $ 0.11 $ 0.26 $ 0.51 Net income per share - diluted $ 0.06 $ 0.11 $ 0.26 $ 0.51

Note 8 - Business Segments (Tab

Note 8 - Business Segments (Tables)	9 Months Ended
	Sep. 30, 2021
Notes Tables
Reconciliation of Revenue and Operating Profit Loss from Segments to Consolidated [Table Text Block]	Three Months Ended September 30, Nine Months Ended September 30, Revenues, net: 2021 2020 2021 2020 Workforce Solutions $ 51,155 $ 49,197 $ 154,559 $ 147,909 Provider Solutions 12,936 11,686 37,815 35,099 Total revenues, net $ 64,091 $ 60,883 $ 192,374 $ 183,008 Operating income: Workforce Solutions $ 7,732 $ 9,758 $ 25,981 $ 33,575 Provider Solutions 1,974 913 6,195 3,382 Unallocated (7,921 ) (7,537 ) (23,661 ) (22,276 ) Total operating income $ 1,785 $ 3,134 $ 8,515 $ 14,681
Reconciliation of Assets from Segment to Consolidated [Table Text Block]	Segment assets * September 30, 2021 December 31, 2020 Workforce Solutions $ 259,036 $ 270,924 Provider Solutions 134,793 140,490 Unallocated 100,885 88,899 Total assets $ 494,714 $ 500,313

Note 2 - Revenue Recognition _3

Note 2 - Revenue Recognition and Sales Commissions 1 (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Contract with Customer, Liability, Revenue Recognized	$ 39,400	$ 34,400	$ 59,300	$ 60,500
Revenue, Remaining Performance Obligation, Amount	446,000		$ 446,000
Sales Commissions, Amortization Term (Year)			3 years
Amortization of Deferred Sales Commissions	$ 2,400	$ 2,300	$ 6,900	6,555
Customer Contracts [Member]
Asset Impairment Charges, Total			$ 100	$ 200

Note 2 - Revenue Recognition _4

Note 2 - Revenue Recognition and Sales Commissions 2 (Details Textual) - Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-10-01	Sep. 30, 2021
Revenue, Remaining Performance Obligation, Percentage	46.00%
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Period (Month)	12 months

Note 2 - Revenue Recognition _5

Note 2 - Revenue Recognition and Sales Commissions - Revenues Disaggregated By Revenue Source (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues	$ 64,091	$ 60,883	$ 192,374	$ 183,008
Subscription Services [Member]
Revenues	60,702	58,245	182,714	174,882
Professional Services [Member]
Revenues	3,389	2,638	9,660	8,126
Healthstream Workforce Solutions [Member]
Revenues	51,155	49,197	154,559	147,909
Healthstream Workforce Solutions [Member] | Subscription Services [Member]
Revenues	49,729	48,246	150,239	144,945
Healthstream Workforce Solutions [Member] | Professional Services [Member]
Revenues	1,426	951	4,320	2,964
Healthstream Provider Solutions [Member]
Revenues	12,936	11,686	37,815	35,099
Healthstream Provider Solutions [Member] | Subscription Services [Member]
Revenues	10,973	9,999	32,475	29,937
Healthstream Provider Solutions [Member] | Professional Services [Member]
Revenues	$ 1,963	$ 1,687	$ 5,340	$ 5,162

Note 3 - Income Taxes (Details

Note 3 - Income Taxes (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Tax Expense (Benefit), Total	$ 186	$ 600	$ 2,033	$ 3,519
Effective Income Tax Rate Reconciliation, Percent, Total			25.00%	21.00%
Effective Income Tax Rate Reconciliation, Change in Enacted Tax Rate, Amount			$ 200
Nurse Grid [Member]
Income Tax Expense (Benefit), Total				$ (300)
Change in Unrealized Gain (Loss) on Hedged Item in Fair Value Hedge				$ 1,200

Note 4 - Shareholders' Equity_2

Note 4 - Shareholders' Equity (Details Textual) - Restricted Stock Units (RSUs) [Member] - $ / shares	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period (in shares)	129,906	114,784
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period, Weighted Average Grant Date Fair Value (in dollars per share)	$ 23.44	$ 22.94

Note 4 - Shareholders' Equity -

Note 4 - Shareholders' Equity - Summary of Stock-based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Stock-based compensation expense	$ 862	$ 557	$ 2,260	$ 1,665
Cost of Sales [Member]
Stock-based compensation expense	31	16	82	39
Product Development [Member]
Stock-based compensation expense	111	92	329	266
Selling and Marketing Expense [Member]
Stock-based compensation expense	76	60	217	170
General and Administrative Expense [Member]
Stock-based compensation expense	$ 644	$ 389	$ 1,632	$ 1,190

Note 5 - Earnings Per Share (De

Note 5 - Earnings Per Share (Details Textual) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	26,000	115,000	95,000	112,000

Note 5 - Earnings Per Share - C

Note 5 - Earnings Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2021	Sep. 30, 2020
Net income	$ 1,500	$ 2,441	$ 2,291	$ 2,634	$ 3,442	$ 7,092	$ 6,232	$ 13,168
Weighted-average shares outstanding (in shares)	31,558			31,955			31,538	32,095
Effect of dilutive shares (in shares)	126			26			71	26
Weighted-average diluted shares (in shares)	31,684			31,981			31,609	32,121
Net income per share, basic (in dollars per share)	$ 0.05			$ 0.08			$ 0.20	$ 0.41
Net income per share, diluted (in dollars per share)	$ 0.05			$ 0.08			$ 0.20	$ 0.41

Note 6 - Marketable Securitie_2

Note 6 - Marketable Securities (Details Textual) $ in Thousands	Sep. 30, 2021USD ($)
Debt Securities, Available-for-sale, Allowance for Credit Loss, Ending Balance	$ 0

Note 6 - Marketable Securitie_3

Note 6 - Marketable Securities - Fair Value of Available for Sale Marketable Securities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Adjusted Cost	$ 60,555	$ 46,502
Unrealized Gains	0	0
Unrealized Losses	(1)	(8)
Fair Value	60,554	46,494
Cash and Cash Equivalents	55,459	36,566
Current Marketable Securities	5,095	9,928
Cash [Member]
Adjusted Cost	55,459	31,558
Unrealized Gains	0	0
Unrealized Losses	0	0
Fair Value	55,459	31,558
Cash and Cash Equivalents	55,459	31,558
Current Marketable Securities	0	0
Bank Time Deposits [Member] | Fair Value, Inputs, Level 2 [Member]
Adjusted Cost		10,021
Unrealized Gains		0
Unrealized Losses		0
Fair Value		10,021
Cash and Cash Equivalents		5,008
Current Marketable Securities		5,013
Corporate Debt Securities [Member] | Fair Value, Inputs, Level 2 [Member]
Adjusted Cost	5,096	4,923
Unrealized Gains	0	0
Unrealized Losses	(1)	(8)
Fair Value	5,095	4,915
Cash and Cash Equivalents	0	0
Current Marketable Securities	$ 5,095	$ 4,915

Note 7 - Business Combination_2

Note 7 - Business Combinations (Details Textual) - USD ($)	Jan. 19, 2021	Dec. 10, 2020	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020	Mar. 31, 2020	Sep. 30, 2021	Sep. 30, 2020
Payments to Acquire Businesses, Net of Cash Acquired, Total							$ 731,000	$ 21,449,000
Goodwill, Period Increase (Decrease), Total							2,700,000
Goodwill, Foreign Currency Translation Gain (Loss)							200,000
Nurse Grid [Member]
Payments to Acquire Businesses, Net of Cash Acquired, Total					$ 21,500,000
Business Combination, Step Acquisition, Equity Interest in Acquiree, Fair Value					3,623,000
Business Combination, Step Acquisition, Equity Interest in Acquiree, Remeasurement Gain						$ 1,200,000
Business Acquisition, Transaction Costs					200,000
Deferred Revenue Included in Net Tangible Assets, Book Value					157,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue					78,000
Write-down of Deferred Revenue					79,000
Payments to Acquire Businesses, Gross					$ 25,485,000
ShiftWizard [Member]
Payments to Acquire Businesses, Net of Cash Acquired, Total				$ 30,500,000
Business Acquisition, Transaction Costs				300,000
Deferred Revenue Included in Net Tangible Assets, Book Value				2,700,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue				1,601,000
Write-down of Deferred Revenue				1,100,000
Business Combination, Indemnification Asset and Liability, Related to Paycheck Protection, Program Loan as of Acquisition Date				$ 500,000
ANSOS Staff Scheduling Application [Member]
Business Acquisition, Transaction Costs			$ 1,200,000
Deferred Revenue Included in Net Tangible Assets, Book Value			17,500,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Liabilities, Deferred Revenue			14,204,000
Write-down of Deferred Revenue			3,300,000
Payments to Acquire Businesses, Gross			$ 66,400,000
Preliminary Purchase Price Allocation, Measurement Period from Acquisition Date (Year)			1 year
Goodwill, Purchase Accounting Adjustments			$ 1,500,000				1,500,000
Business Acquisition, Goodwill, Expected Tax Deductible Amount, Percentage			95.00%
MyClinicalExchange [Member]
Business Acquisition, Transaction Costs		$ 100,000
Payments to Acquire Businesses, Gross		$ 4,400,000
ProcessDATA, Limited [Member]
Business Acquisition, Transaction Costs	$ 100,000
Payments to Acquire Businesses, Gross	$ 2,000,000
ComplyALIGN [Member]
Goodwill, Acquired During Period							$ 1,000,000

Note 7 - Business Combination_3

Note 7 - Business Combinations - Summary of Purchase Price (Details) - Nurse Grid [Member] $ in Thousands	Mar. 09, 2020USD ($)
Cash paid at closing	$ 25,485
Post-closing adjustment, net of cash received	33
Cash acquired	(4,064)
Net consideration paid	21,454
Fair value of existing equity interest in NurseGrid	3,623
Net consideration paid	$ 25,077

Note 7 - Business Combination_4

Note 7 - Business Combinations - Summary of Preliminary Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($)	Sep. 30, 2021	Dec. 31, 2020	Dec. 02, 2020	Oct. 12, 2020	Mar. 09, 2020
Goodwill	$ 181,114,000	$ 178,440,000
Nurse Grid [Member]
Accounts and unbilled receivable, net					$ 92,000
Prepaid and other current assets					155,000
Operating lease right-of-use assets					50,000
Deferred tax assets					2,121,000
Goodwill					21,085,000
Intangible assets					1,845,000
Accounts payable and accrued liabilities					(143,000)
Deferred revenue					(78,000)
Operating lease liabilities					(50,000)
Net assets acquired					$ 25,077,000
ShiftWizard [Member]
Accounts and unbilled receivable, net				$ 1,038,000
Prepaid and other current assets				106,000
Operating lease right-of-use assets				183,000
Goodwill				19,307,000
Intangible assets				12,660,000
Accounts payable and accrued liabilities				(600,000)
Deferred revenue				(1,601,000)
Operating lease liabilities				(183,000)
Net assets acquired				30,492,000
Cash				1,091,000
Property and equipment				50,000
Indemnification assets				464,000
Deferred tax liability				(1,559,000)
Indemnification liability				(464,000)
ANSOS Staff Scheduling Application [Member]
Accounts and unbilled receivable, net			$ 10,099,000
Prepaid and other current assets			233,000
Operating lease right-of-use assets			888,000
Deferred tax assets			2,855,000
Goodwill			36,748,000
Intangible assets			32,440,000	$ 32,440,000
Accounts payable and accrued liabilities			(1,776,000)
Deferred revenue			(14,204,000)
Operating lease liabilities			(888,000)
Net assets acquired			66,448,000
Cash			1,599,000
Property and equipment			66,000
Indemnification assets			2,029,000
Deferred tax liability			(1,612,000)
Uncertain tax position liability			$ (2,029,000)

Note 7 - Business Combination_5

Note 7 - Business Combinations - Summary of Components of Identifiable Intangible Assets and Estimated Useful Lives (Details) - USD ($) $ in Thousands	Oct. 12, 2020	Mar. 09, 2020	Dec. 02, 2020
Nurse Grid [Member]
Intangible assets, fair value		$ 1,845
Nurse Grid [Member] | Trade Names [Member]
Intangible assets, fair value		700
Nurse Grid [Member] | Customer Relationships [Member]
Intangible assets, fair value		$ 35
Intangible assets, useful life (Year)		8 years
Nurse Grid [Member] | Developed Technology Rights [Member]
Intangible assets, fair value		$ 1,110
Intangible assets, useful life (Year)		5 years
ANSOS Staff Scheduling Application [Member]
Intangible assets, fair value	$ 32,440		$ 32,440
ANSOS Staff Scheduling Application [Member] | Customer Relationships [Member]
Intangible assets, fair value	$ 21,100
ANSOS Staff Scheduling Application [Member] | Customer Relationships [Member] | Minimum [Member]
Intangible assets, useful life (Year)	11 years
ANSOS Staff Scheduling Application [Member] | Customer Relationships [Member] | Maximum [Member]
Intangible assets, useful life (Year)	14 years
ANSOS Staff Scheduling Application [Member] | Developed Technology Rights [Member]
Intangible assets, fair value	$ 9,800
Intangible assets, useful life (Year)	5 years
ANSOS Staff Scheduling Application [Member] | Trade Name [Member]
Intangible assets, fair value	$ 1,540
Intangible assets, useful life (Year)	10 years
ShiftWizard [Member]
Intangible assets, fair value	$ 12,660
ShiftWizard [Member] | Customer Relationships [Member]
Intangible assets, fair value	$ 7,800
Intangible assets, useful life (Year)	18 years
ShiftWizard [Member] | Developed Technology Rights [Member]
Intangible assets, fair value	$ 4,050
Intangible assets, useful life (Year)	5 years
ShiftWizard [Member] | Trade Name [Member]
Intangible assets, fair value	$ 230
Intangible assets, useful life (Year)	5 years
ShiftWizard [Member] | Noncompete Agreements [Member]
Intangible assets, fair value	$ 580
ShiftWizard [Member] | Noncompete Agreements [Member] | Minimum [Member]
Intangible assets, useful life (Year)	1 year
ShiftWizard [Member] | Noncompete Agreements [Member] | Maximum [Member]
Intangible assets, useful life (Year)	5 years

Note 7 - Business Combination_6

Note 7 - Business Combinations - Summary of Unaudited Pro Forma Financial Information (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Nurse Grid [Member]
Total revenues	$ 64,091	$ 60,900	$ 192,379	$ 183,133
Net income	$ 1,500	$ 2,648	$ 6,236	$ 12,632
Net income per share - basic (in dollars per share)	$ 0.05	$ 0.08	$ 0.20	$ 0.39
Net income per share - diluted (in dollars per share)	$ 0.05	$ 0.08	$ 0.20	$ 0.39
ShiftWizard [Member]
Total revenues	$ 64,210	$ 61,930	$ 192,910	$ 186,049
Net income	$ 1,615	$ 2,169	$ 6,690	$ 11,985
Net income per share - basic (in dollars per share)	$ 0.05	$ 0.07	$ 0.21	$ 0.37
Net income per share - diluted (in dollars per share)	$ 0.05	$ 0.07	$ 0.21	$ 0.37
ANSOS Staff Scheduling Application [Member]
Total revenues	$ 64,636	$ 66,924	$ 194,856	$ 203,129
Net income	$ 1,965	$ 3,407	$ 8,190	$ 16,514
Net income per share - basic (in dollars per share)	$ 0.06	$ 0.11	$ 0.26	$ 0.51
Net income per share - diluted (in dollars per share)	$ 0.06	$ 0.11	$ 0.26	$ 0.51

Note 8 - Business Segments - Bu

Note 8 - Business Segments - Business Segment Information Based on Net Revenues and Operating Income (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenues, net	$ 64,091	$ 60,883	$ 192,374	$ 183,008
Operating income	1,785	3,134	8,515	14,681
Segment Reconciling Items [Member]
Operating income	(7,921)	(7,537)	(23,661)	(22,276)
Healthstream Workforce Solutions [Member]
Revenues, net	51,155	49,197	154,559	147,909
Healthstream Workforce Solutions [Member] | Operating Segments [Member]
Revenues, net	51,155	49,197	154,559	147,909
Operating income	7,732	9,758	25,981	33,575
Healthstream Provider Solutions [Member]
Revenues, net	12,936	11,686	37,815	35,099
Healthstream Provider Solutions [Member] | Operating Segments [Member]
Revenues, net	12,936	11,686	37,815	35,099
Operating income	$ 1,974	$ 913	$ 6,195	$ 3,382

Note 8 - Business Segments - _2

Note 8 - Business Segments - Business Segment Information Based on Assets (Details) - USD ($) $ in Thousands		Sep. 30, 2021	Dec. 31, 2020
Segment assets	[1]	$ 494,714	$ 500,313
Operating Segments [Member] | Healthstream Workforce Solutions [Member]
Segment assets	[1]	259,036	270,924
Operating Segments [Member] | Healthstream Provider Solutions [Member]
Segment assets	[1]	134,793	140,490
Segment Reconciling Items [Member]
Segment assets	[1]	$ 100,885	$ 88,899
[1]	Segment assets include accounts and unbilled receivables, prepaid royalties, prepaid and other current assets, other assets, capitalized software development, deferred commissions, certain property and equipment, goodwill, and intangible assets. Cash and cash equivalents, marketable securities, non-marketable equity investments, and certain ROU assets are not allocated to individual segments and are included within Unallocated. A significant portion of property and equipment assets are included within Unallocated.

Note 9 - Debt (Details Textual)

Note 9 - Debt (Details Textual) - Revolving Credit Facility [Member] - Truist Bank [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)
Debt Instrument, Covenant, Maximum Funded Debt Leverage Ratio	3
Debt Instrument, Covenant, Interest Coverage Ratio	3
Long-term Line of Credit, Total	$ 0
Minimum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	20.00%
Maximum [Member]
Line of Credit Facility, Unused Capacity, Commitment Fee Percentage	30.00%
Third Amendment [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 65,000
Line of Credit Facility, Increased Facility Size Due to Accordion Feature	$ 25,000
Third Amendment [Member] | Fed Funds Effective Rate Overnight Index Swap Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	0.50%
Third Amendment [Member] | Base Rate [Member]
Debt Instrument, Basis Spread on Variable Rate	1.00%
Third Amendment [Member] | Base Rate [Member] | Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.50%
Third Amendment [Member] | Base Rate [Member] | Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	0.75%
Third Amendment [Member] | Eurodollar [Member] | Minimum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.50%
Third Amendment [Member] | Eurodollar [Member] | Maximum [Member]
Line of Credit Facility, Percentage of Applicable Margin for Borrowings	1.75%
Third Amendment [Member] | Swing Line Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000
Third Amendment [Member] | Letter of Credit Subfacility [Member]
Line of Credit Facility, Maximum Borrowing Capacity	$ 5,000