Despite extraordinary complexities new ‘omics technologies are delivering solidly on precision and prediction in research and clinical applications. Successful targeting and monitoring in certain cancers is not only game-changing for an increasing number of patients, it also stands to help shape other new clinical applications. However tremendous technical complexity and lack of standards results in daunting challenges like making biomarkers robust enough for patient care decision-making, and tying systems biology together and to patient electronic health records and consumer data clouds. The article reviews these challenges and the progress being made. It also introduces the unmet need of understanding the ultimate demand of the patient as consumer.