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The power of next-generation sequencing (NGS) for infectious disease diagnosis lies in the ability to sensitively detect pathogens that routinely elude diagnosis by conventional testing. There remain significant challenges, however, with respect to sample preparation, cost, turnaround time, bioinformatics analysis of complex data, and regulatory issues. Introduction of NGS into the clinical setting requires rigorous criteria for defining the presence or absence of pathogenic microbes, quantification of pathogen levels, genome assembly, and the use of appropriate reference databases and biomarkers. Here we discuss: 1. Validation of an NGS-based assay for infectious disease diagnosis in a clinical laboratory 2. Implementation of a flexible, automated, and cloud-compatible pipeline for pathogen detection in metagenomic NGS data 3. Leveraging of NGS to identify diagnostic biomarkers of infectious disease by global transcriptome profiling 4. Specific examples of the use of NGS for microbial diagnosis in clinical settings. Charles Chiu, MD, PhD associate professor, Laboratory Medicine and Medicine/Infectious Diseases director, UCSF-Abbott Viral Diagnostics and Discovery Center University of California, San Francisco School of Medicine 1/14/2015 http://uwtv.org