The Victorian Clinical Genetics Service was one of the first laboratories in Australia to be accredited for clinical genomic testing, and today is the one of the largest and most comprehensive providers of genomic tests in the country. Our offering ranges from pre-conception and prenatal screening to ultra-rapid diagnostic testing, and our relationship with the Murdoch Children’s Research Institute puts a strong focus on translation of new technologies with the aim to remain a leader in clinical translation. Here we will discuss past, current and future challenges of clinical genomic service delivery, and what we see as the likely solutions.