At present when editing portal update records the system defaults to "Include all" and there is no option to "exclude all" so that the provider might selectively determine which portions of the CDA to publish to the patient. This has resulted in a serious workflow problem for my providers. For example, an 80-year-old patient who has been seen in the office multiple times in the last few months is receiving a full CDA every time there is an update to her labs or other related records. In order for the provider to selectively send only the lab related information the provider must manually uncheck more than100 items in the CDA. It would be a significant improvement to work flow if you were able to deselect all and selectively check the items to be published.