Energy efficiency in buildings is one of the main goals of many governmental policies due to their high impact on the carbon dioxide emissions in Europe. One of these targets is to reduce the energy consumption in healthcare buildings, which are known to be among the most energy-demanding building types. Although design decisions made at early design phases have a significant impact on the energy performance of the realized buildings, only a small portion of possible early designs is analyzed, which does not ensure an optimal building design. We propose an automated early design support workflow, accompanied by a set of tools, for achieving nearly zero emission healthcare buildings. It is intended to be used by decision makers during the early design phase. It starts with the user-defined brief and the design rules, which are the input for the Early Design Configurator (EDC). The EDC generates multiple design alternatives following an evolutionary algorithm while trying to satisfy user requirements and geometric constraints. The generated alternatives are then validated by means of an Early Design Validator (EDV), and then, early energy and cost assessments are made using two early assessment tools. A user-friendly dashboard is used to guide the user and to illustrate the workflow results, whereas the chosen alternative at the end of the workflow is considered as the starting point for the next design phases. Our proposal has been implemented using Building Information Models (BIM) and validated by means of a case study on a healthcare building and several real demonstrations from different countries in the context of the European project STREAMER.