You basically have the kernel eventfd notify you about any access triggered (Based on your configuration), so from userspace, you have the eventfd and then you mmap the shared lock-less ring buffer that actually contains the events PCIem notifies (So you don't end up busy polling).
You basically mmap a struct pciem_shared_ring where you'll have your usual head/tail pointers.
From then on, on your main, you'd have a select() or a poll() for the eventfd; when PCIem notifies the userspace you'd check head != tail (Which means there are events to process) and you can basically do:
struct pciem_event *event = &event_ring->events[head]; atomic_thread_fence(memory_order_acquire); if (event->type == PCIEM_EVENT_MMIO_WRITE) handle_mmio_read(...);
And that's it, don't forget to update the head pointer!
I'll go and update the docs now. Hopefully this clears stuff up!