ELFI – EcoLogical Framework for Medical Interventions

Across borders, the demand for more sustainable healthcare is growing. ELFI addresses this challenge by integrating environmental impact into medical decision-making—empowering both patients and healthcare professionals.

Start Date

December, 2025

Programme

Interreg Deutschland - Nederland

Duration

3.5 years

Funding

€3 million

| About ELFI

The ELFI project (EcoLogical Framework for Medical Interventions) aims to reduce the environmental impact of healthcare by integrating ecological considerations into medical decision-making.

Traditionally, medical decisions are based on effectiveness and potential risks. ELFI adds a crucial third dimension: environmental impact. By embedding this information into existing decision aids, the project supports more sustainable and informed choices.

Patients are empowered to actively participate in decisions that consider both their health and the environment. At the same time, healthcare professionals gain access to structured information that helps them recommend more sustainable treatment options.

| Why sustainable healthcare?

Healthcare systems contribute significantly to environmental impacts such as carbon emissions, energy consumption, and waste generation. Despite this, environmental aspects are rarely considered in clinical decision-making.

ELFI addresses this gap by identifying key environmental hotspots—such as electricity use and material waste—and making this information accessible and actionable.

By integrating sustainability into everyday medical decisions, ELFI contributes to a more resilient and future-proof healthcare system.

| What we do

ELFI focuses on three common, non-life-threatening conditions for which multiple treatment options exist. These include lifestyle interventions, medication, physiotherapy, and surgical procedures.

For each option, the project:

Systematically analyses environmental impacts using Life Cycle Assessments (LCA)
Identifies key drivers of environmental burden
Translates findings into user-friendly formats for decision aids

This enables both patients and healthcare professionals to consider environmental aspects alongside clinical outcomes.

| Our approach

ELFI combines scientific analysis with practical implementation:

Life Cycle Analysis (LCA): Assessing the environmental footprint of treatments
Decision Aid Integration: Embedding results into existing decision-making tools
Cross-border Collaboration: Bringing together expertise from Germany and the Netherlands
Implementation Tools: Developing a practical checklist for healthcare providers

This structured approach ensures that sustainability becomes an integral part of healthcare decision-making.

| Project Structure: Work Packages

ELFI is organised into interconnected work packages that ensure a structured and practice-oriented implementation:

This work package develops and compares standardized treatment pathways for three common conditions: pelvic organ prolapse, uterine fibroids, and gallbladder diseases in Germany and the Netherlands. It covers the full treatment process, from conservative care to surgery. It also collects data on resources used, such as materials, energy, transport, and follow-up care. This forms the basis for further analysis in the project.

This work package examines the environmental impact of medical treatments. Using the data from WP1, treatment pathways are evaluated with a life cycle assessment (LCA) method. The method is first tested and then applied in both countries. The results are stored in a central database and prepared to support decision-making in healthcare.

This work package improves patient decision aids in Germany and the Netherlands. First, shared standards are developed. Content is translated using AI, medically reviewed, and adapted for both countries. Good practice examples are also collected. Next, environmental results from WP2 are integrated into the decision aids. These updated tools are tested with patients and evaluated to see how they influence understanding and decision-making.

This work package focuses on bringing the results into real healthcare practice. Environmental findings are included in clinical guidelines. Some improvements (“quick wins”) are implemented directly in hospitals and shared in workshops. In the long term, recommendations are developed to reduce environmental impact in healthcare and to monitor it more consistently.

| Project Partners

ELFI is a cross-border collaboration involving leading healthcare institutions, research organisations, and innovation partners.

| ELFI Project Funding

The ELFI project is being carried out as part of the Interreg VI Germany-Netherlands programme and is co-funded by the European Union, the Dutch Ministry of Economic Affairs (EZ), the MWIKE NRW and the provinces of Groningen and Gelderland, with a total of €2,165,224.32.