For nearly two decades, microarrays and short-read sequencing have been the foundation of clinical genomics but they come with limits. Enter nanopore sequencing: a technology that reads native DNA and RNA in real time, capturing single nucleotide variants, structural changes, methylation patterns, and even RNA modifications, all in one assay. With applications from intraoperative tumour diagnosis to liquid biopsies, nanopore sequencing is redefining what’s possible in precision medicine.