Understanding the human genome and its interaction with the environment has the potential to change medical care by tailoring interventions to the precise needs of the individual patient. Little of this knowledge is currently being used in care. There are well recognized barriers to its use including lack of sufficient evidence of benefit, inadequate education of the provider workforce, concerns about privacy and reimbursement. However, there are also gaps in the current healthcare delivery system, particularly between traditional public health departments and clinical care that impede the translation of knowledge into practice. While this problem is not limited to genomics, the purpose of this article is to identify these gaps and propose potential solutions using examples from genomic medicine from the perspective of the United States healthcare system.